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Qin X, Fan G, Liu Q, Wu M, Bi J, Fang Q, Mei S, Wan Z, Lv Y, Song L, Wang Y. Association between essential metals, adherence to healthy lifestyle behavior, and ankle-brachial index. J Trace Elem Med Biol 2024; 85:127477. [PMID: 38865925 DOI: 10.1016/j.jtemb.2024.127477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Revised: 05/10/2024] [Accepted: 05/20/2024] [Indexed: 06/14/2024]
Abstract
BACKGROUND Ankle-brachial index (ABI) is a noninvasive diagnostic method for peripheral arterial disease (PAD) and a predictor of cardiovascular events. OBJECTIVE The present study aimed to evaluate the association between individual or combined essential metals and ABI, as well as assess the collective impact of essential metals when coupled with healthy lifestyle on ABI. METHODS A total of 2865 participants were recruited in Wuhan Tongji Hospital between August 2018 and March 2019. Concentrations of essential metals in urine were measured by inductively coupled plasma mass spectrometer. RESULTS The results of general linear regression models demonstrated that after adjusting for confounding factors, there was a positive association between ABI increase and per unit increase of log 10-transformed, creatinine-corrected urinary Cr (β (95 % CI): 0.010 (0.004, 0.016), PFDR = 0.007), Fe (β (95 % CI): 0.010 (0.003, 0.017), PFDR = 0.018), and Co (β (95 % CI): 0.013 (0.005, 0.021), PFDR = 0.007). The WQS regression revealed a positive relationship between the mixture of essential metals and ABI (β (95 % CI): 0.006 (0.003, 0.010), P < 0.001), with Cr and Co contributing most to the relationship (weighted 45.48 % and 40.14 %, respectively). Compared to individuals with unfavorable lifestyle and the lowest quartile of Cr, Fe and Co, those with favorable lifestyle and the highest quartile of Cr, Fe and Co exhibited the most increase in ABI (β (95 % CI): 0.030 (0.017, 0.044) for Cr, β (95 % CI): 0.027 (0.013, 0.040) for Fe, and β (95 % CI): 0.030 (0.016, 0.044) for Co). CONCLUSION In summary, our study indicates that adequate essential metal intake together with healthy lifestyle behaviors perform crucial roles in PAD protection.
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Affiliation(s)
- Xiya Qin
- Department of Maternal and Child Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, HangKong Road 13, Wuhan, Hubei 430030, China; Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, and State Key Laboratory of Environmental Health (Incubation), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Gaojie Fan
- Department of Maternal and Child Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, HangKong Road 13, Wuhan, Hubei 430030, China; Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, and State Key Laboratory of Environmental Health (Incubation), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Qing Liu
- Department of Maternal and Child Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, HangKong Road 13, Wuhan, Hubei 430030, China; Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, and State Key Laboratory of Environmental Health (Incubation), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Mingyang Wu
- Department of Maternal and Child Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, HangKong Road 13, Wuhan, Hubei 430030, China; Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, and State Key Laboratory of Environmental Health (Incubation), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Jianing Bi
- Department of Maternal and Child Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, HangKong Road 13, Wuhan, Hubei 430030, China; Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, and State Key Laboratory of Environmental Health (Incubation), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Qing Fang
- Department of Maternal and Child Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, HangKong Road 13, Wuhan, Hubei 430030, China; Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, and State Key Laboratory of Environmental Health (Incubation), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Surong Mei
- Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, and State Key Laboratory of Environmental Health (Incubation), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Zhengce Wan
- Health Management Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Yongman Lv
- Health Management Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Lulu Song
- Department of Maternal and Child Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, HangKong Road 13, Wuhan, Hubei 430030, China; Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, and State Key Laboratory of Environmental Health (Incubation), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.
| | - Youjie Wang
- Department of Maternal and Child Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, HangKong Road 13, Wuhan, Hubei 430030, China; Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, and State Key Laboratory of Environmental Health (Incubation), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.
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Roshan R, Chaudhary N, Chouhan U, Huda F, Basu S. Correlation of ankle-wrist pressure index with ankle-brachial pressure index to assess lower limb perfusion in diabetic foot ulcer: a pilot study. J Wound Care 2024; 33:519-525. [PMID: 38967344 DOI: 10.12968/jowc.2021.0024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/06/2024]
Abstract
OBJECTIVE The presence of peripheral artery disease (PAD) in patients with diabetic foot ulcers (DFUs) is a significant risk factor for chronicity and amputation. Ankle-brachial pressure index (ABPI) is a screening tool for PAD. Brachial systolic pressure measurement, used as a denominator in the calculation of ABPI, produces inaccurate results in patients with obesity and the presence of heavy clothing. The wrist, however, is easily accessible, and the ankle-wrist pressure index (AWPI), if comparable with ABPI, may be useful in screening selected patients. This study aimed to assess the efficacy of AWPI in diagnosing perfusion in DFUs and compare it to ABPI in patients with DFUs. METHOD ABPI and AWPI were calculated by measuring systolic blood pressure in the arteries of the ankle, arm and wrist with a handheld Doppler. Actual perfusion was determined by the presence or absence of PAD by duplex ultrasound. RESULTS A total of 46 lower extremities in 41 patients were studied. The prevalence of PAD was 61%. Duplex ultrasound confirmed that the sensitivity of ABPI and AWPI in detecting PAD in patients with DFUs was 67.9% and 71.4% respectively, whereas the specificity of ABPI and AWPI was 94.4% and 88.9% respectively. On receiver operating characteristic analysis, the area under the curve of ABPI and AWPI was 0.804 and 0.795, respectively. A statistically significant positive correlation between ABPI and AWPI was found (r=0.986; p<0.001). CONCLUSION There was a good correlation between ABPI and AWPI over a wide range of values. ABPI and AWPI may have a similar role in predicting perfusion in patients with DFUs. AWPI could be used in place of ABPI in selected patients in whom measuring ABPI may be difficult. DECLARATION OF INTEREST The authors have no conflicts of interest to declare.
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Affiliation(s)
- Ravi Roshan
- Department of Surgery, All India Institute of Medical Sciences, Rishikesh, India
| | - Natasha Chaudhary
- Department of Surgery, All India Institute of Medical Sciences, Rishikesh, India
| | - Udit Chouhan
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Rishikesh, India
| | - Farhanul Huda
- Department of Surgery, All India Institute of Medical Sciences, Rishikesh, India
| | - Somprakas Basu
- Department of Surgery, All India Institute of Medical Sciences, Rishikesh, India
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Jihong S, Xiaojie C, He L, Yifan Z. Association between the triglyceride glucose index and atherosclerotic cardiovascular disease in the general population: analysis of the national health and nutrition examination survey 1999-2004. Front Endocrinol (Lausanne) 2024; 15:1376357. [PMID: 38836226 PMCID: PMC11148275 DOI: 10.3389/fendo.2024.1376357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 04/30/2024] [Indexed: 06/06/2024] Open
Abstract
Objective The triglyceride-glucose (TyG) index, a reliable substitute indicator of insulin resistance (IR), is considered an independent risk factor for long-term outcomes in patients with cardiovascular disease. However, studies investigating the association between TyG and atherosclerotic cardiovascular disease (ASCVD) are limited and lack direct evidence. We aim to examine the relationship between the TyG index and ASCVD through a comprehensive cross-sectional study. Methods Overall, 7212 participants from the 1999-2004 National Health and Nutrition Examination Survey were included. The baseline TyG index was calculated as ln [fasting triglyceride (mg/dL) × fasting blood glucose (mg/dL)/2]. Restricted cubic spline (RCS) regression, univariate logistic regression, and multivariate logistic regression analysis were used to evaluate the association between the TyG index and ASCVD. Results In the overall population, a multivariate logistic regression analysis showed that the TyG level was not only positively associated with ASCVD [OR (95%CI): 1.29 (1.01,1.64), P=0.042], coronary artery disease (CAD) [OR (95%CI): 1.82(1.33,2.48), P<0.001], and stroke [OR (95%CI): 2.68(1.54,4.69), P=0.002], but also linearly correlated with all three (P-overall<0.001; P-non-linear >0.05). Although the TyG index was not associated with peripheral arterial disease (PAD) [OR (95%CI): 1.00 (0.73,1.36), P>0.900], it showed a U-shaped correlation with PAD (P-overall <0.001; P-non-linear= 0.0085), and the risk of PAD was minimized when TyG=8.67. By incorporating the TyG index into the baseline risk model, the accuracy of ASCVD prediction was improved [AUC: baseline risk model, 0.7183 vs. baseline risk model + TyG index, 0.7203, P for comparison=0.034]. The results of the subgroup analysis were consistent with those of the main analysis. Conclusion The TyG index was independently associated with ASCVD, CAD, and stroke, suggesting that it may serve as a valid indicator for predicting ASCVD in the entire population.
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Affiliation(s)
- Sun Jihong
- Department of cardiology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Chen Xiaojie
- Department of cardiology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Lu He
- Department of Radiology, The People's Hospital of Jiawang District of Xuzhou, Xuzhou, Jiangsu, China
| | - Zhao Yifan
- Department of cardiology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
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Wang Y, Wang J. Dietary antioxidant intake increases ankle brachial pressure index in men but not in women: a cross-sectional study. Front Cardiovasc Med 2024; 11:1343135. [PMID: 38390443 PMCID: PMC10881872 DOI: 10.3389/fcvm.2024.1343135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 01/29/2024] [Indexed: 02/24/2024] Open
Abstract
Objective Atherosclerosis is a significant cause of cardiovascular and cerebrovascular diseases, with a greater impact on men than women. Dietary antioxidant intake is inversely related to the risk of atherosclerosis development. We aimed to investigate the association between dietary composite antioxidant intake and the ankle brachial pressure index (ABPI). The ABPI is not only used for assessing the progression of arterial lesions but also for stratifying the risk of atherosclerotic disease. Methods We conducted a cross-sectional analysis involving 1,049 participants from the National Health and Nutrition Examination Survey (NHANES). We examined six antioxidants (zinc, selenium, carotenoids, and vitamins A, C, and E) and a composite dietary antioxidant index (CDAI) derived from these antioxidants as exposure variables. The primary outcomes encompassed cardio-metabolic parameters, including body mass index (BMI), body fat mass (BFM), systolic and diastolic blood pressure, triglycerides, HDL and LDL cholesterol, C-reactive protein, and the Ankle-Brachial Pressure Index (ABPI). Associations and interactions between variables were assessed using linear regression analyses. Moreover, mediation and moderation analysis is employed. Results Hierarchical multiple regression analysis revealed that among men, dietary intake of zinc, selenium, and vitamin A remained positively associated with a higher ABPI even after adjusting for covariates. Conversely, in the stratified regression analysis based on CDAI quartiles, a U-shaped association between CDAI and ABPI was suggested. Notably, no significant association between dietary antioxidant intake and ABPI was observed among women. CDAI, intake of Vitamin A, Vitamin C, and Vitamin E do not influence all-cause death through mediation by abpi, but rather have a direct effect on all-cause death. Moreover, there is a significant interaction between the intake of Vitamin A and gender, where a daily intake of Vitamin A more than 776 ug is especially beneficial for women. Conclusion The combined intake of nutrients with antioxidant properties may prevent the initiation and progression of atherosclerosis and influence the outcome in a sex-specific manner.
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Affiliation(s)
- Yuting Wang
- Intensive Care Unit, Zhongshan Hospital (Xiamen), Fudan University, Xiamen, China
| | - Jianfeng Wang
- Department of Dermatology, The First Hospital in Quanzhou Affiliated to Fujian Medical University, Quanzhou, China
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Wynn M, Stephens M, Pradeep S, Clarke‐Cornwell AM, Bianchi J. Clinimetrics of the Lanarkshire Oximetry Index for patients with leg ulcers: A systematic review and meta-analysis. Int Wound J 2023; 21:e14519. [PMID: 38050665 PMCID: PMC10898413 DOI: 10.1111/iwj.14519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 11/13/2023] [Indexed: 12/06/2023] Open
Abstract
Ankle Brachial Pressure Index (ABPI) measurement has long been considered the gold standard of vascular assessment for people with lower limb ulceration. Despite this, only around 15% of patients in the United Kingdom who require an ABPI measurement undergo the assessment. The Lanarkshire Oximetry Index (LOI) is a cheaper and arguably more accessible approach to vascular assessment and was initially proposed as an alternative to the ABPI in 2000. No synthesis of evidence related to the LOI has been performed since its introduction into the literature. Primary studies were sought to determine the clinimetric properties of the LOI and its level of agreement with ABPI assessments. Systematic searches of MEDLINE, CINAHL, Cochrane Central Register of Controlled Trials, BNI, ProQuest Health and Medicine, Science Direct, Google Scholar and the British Library (online search) were conducted. Reference lists of identified studies were also reviewed to identify additional studies. Three primary studies met the inclusion criteria, reporting data from 307 patients and 584 limbs assessed using both the LOI and ABPI. All three studies reported fair to moderate kappa values for interrater reliability (κ = 0.290-0.747) and statistically significant positive correlation coefficients (r = 0.37, p < 0.001 in two studies) between the LOI and ABPI. The combined data from the three studies indicated a sensitivity of 52% (41.78-62.1, 95% confidence interval [CI]) and specificity of 96.08% (93.4-97.9, 95% CI) for the LOI using the ABPI as a reference. Additional data are required to indicate the safety of the LOI in practice. Data are also required to determine if the LOI is more acceptable to clinicians compared to the ABPI and whether there are any barriers/enablers to its implementation in practice. Given the relatively low specificity of the LOI, it may be beneficial to combine measurement of the LOI with a subjective clinical risk assessment tool to improve the sensitivity of this alternative approach to vascular assessment.
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Affiliation(s)
- Matthew Wynn
- School of Health and SocietyUniversity of SalfordSalfordUK
| | | | - Sheba Pradeep
- School of Health and SocietyUniversity of SalfordSalfordUK
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Rastogi A, Sudhayakumar A, Schaper NC, Jude EB. A paradigm shift for cardiovascular outcome evaluation in diabetes: Major adverse cardiovascular events (MACE) to major adverse vascular events (MAVE). Diabetes Metab Syndr 2023; 17:102875. [PMID: 37844433 DOI: 10.1016/j.dsx.2023.102875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 09/29/2023] [Accepted: 10/02/2023] [Indexed: 10/18/2023]
Abstract
BACKGROUND AND AIMS Drugs for diabetes are required to demonstrate cardiovascular safety through CV outcome trials (CVOT). The pre-defined end-points for cardiovascular outcome studies may not be sufficient to capture all clinically relevant atherosclerotic cardio vascular disease (ASCVD) events particularly peripheral arterial disease (PAD). METHODS We planned a scoping review and searched database to identify CVOT conducted in population with diabetes measuring lower limb events due to PAD as the primary outcome measure. We also searched CVOT for reported differential cardiovascular outcomes in population with PAD. RESULTS We identified that CV outcomes are measured as 3 point major adverse cardiovascular outcomes (3P-MACE) that includes nonfatal MI and nonfatal stroke or 4P-MACE that included additional unstable angina which is further expanded to 5P-MACE by the inclusion of hospitalization for heart failure (HHF). These CV end points are captured as surrogate for CV mortality based on the biological plausibility of relation between the surrogate and final outcome from pathophysiological studies. We found the prevalence of PAD is no lesser than other CV events in people with diabetes. Moreover, PAD contributes to the significant morbidity associated with diabetes as a surrogate for mortality. However, none of the CVOT with anti-diabetic drugs include PAD events as primary outcome measure despite the inclusion of 6-25 % participants with PAD in major CVOT. PAD outcomes are objectively measurable with tibial arterial waveforms and clinical end-point as lower extremity amputation. PAD outcomes do improve with treatment including intensive glycemic control and novel oral anticoagulants. We suggest the inclusion of PAD to MACE as a pre-specified outcome for a comprehensive capture of major adverse vascular event in future studies for people with diabetes. CONCLUSIONS MACE should be expanded to include PAD event as major adverse vascular event in cardiovascular outcome studies since PAD is clinically relevant and objectively measurable in diabetes.
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Affiliation(s)
- Ashu Rastogi
- Dept of Endocrinology, PGIMER, Chandigarh, 160012, India.
| | | | - Nicolaas C Schaper
- Division of Endocrinology, Department Internal Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Edward B Jude
- Tameside and Glossop Integrated Care NHS Foundation Trust and University of Manchester, Ashton under Lyne, UK
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Haryanto H, Amrullah S, Jais S, Supriadi S, Imran I, Sari Y. INDIFURUTO: A novel tool for assessing diabetic foot recurrence risk in type 2 diabetes. J Med Life 2023; 16:1514-1518. [PMID: 38313180 PMCID: PMC10835566 DOI: 10.25122/jml-2023-0058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 07/24/2023] [Indexed: 02/06/2024] Open
Abstract
This study aimed to evaluate diabetic foot ulcer recurrence using the Indonesia Diabetic Foot Ulcer Recurrence Assessment Tool (INDIFURUTO), a new diabetic foot risk recurrence assessment tool. This study used a prospective cohort design. A total of thirty-three participants met the inclusion criteria. We used sensitivity, specificity values, AUC, and, respectively, a 95% confidence interval (CI) to calculate prognostic accuracy measures. The results showed that this study had an AUC of 0,97 [95% confidence interval (CI) 0.91-1.00]. The cut-off point (Youden Index) was <45, with sensitivity and specificity values of 100% and 90%, respectively. The utilization of this model can facilitate the monitoring and enhancement of foot ulcer recurrence prevention in individuals diagnosed with diabetes. This study showed that the new model had a high prediction. Therefore, this model better stratifies people at high risk of foot ulceration.
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Affiliation(s)
- Haryanto Haryanto
- Department of Medical Surgical, Wound Management and Critical Nursing, Institut Teknologi dan Kesehatan Muhammadiyah, Kalimantan Barat, Pontianak, Indonesia
| | - Syahid Amrullah
- Department of Medical Surgical, Wound Management and Critical Nursing, Institut Teknologi dan Kesehatan Muhammadiyah, Kalimantan Barat, Pontianak, Indonesia
| | - Suriadi Jais
- Department of Medical Surgical, Wound Management and Critical Nursing, Institut Teknologi dan Kesehatan Muhammadiyah, Kalimantan Barat, Pontianak, Indonesia
| | - Supriadi Supriadi
- Department of Medical Surgical, Wound Management and Critical Nursing, Institut Teknologi dan Kesehatan Muhammadiyah, Kalimantan Barat, Pontianak, Indonesia
| | - Imran Imran
- Department of Medical Surgical, Wound Management and Critical Nursing, Institut Teknologi dan Kesehatan Muhammadiyah, Kalimantan Barat, Pontianak, Indonesia
| | - Yunita Sari
- Department of Nursing, Faculty of Health Sciences, Universitas Jenderal Soedirman, Purwokerto, Indonesia
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Yadav U, Kumar N, Sarvottam K. Role of obesity related inflammation in pathogenesis of peripheral artery disease in patients of type 2 diabetes mellitus. J Diabetes Metab Disord 2023; 22:175-188. [PMID: 37255816 PMCID: PMC10225462 DOI: 10.1007/s40200-023-01221-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 03/29/2023] [Indexed: 06/01/2023]
Abstract
Objective Type 2 diabetes mellitus (T2DM) has emerged as one of the greatest global health challenges of twenty-first century. Visceral obesity is one of the most important determinant of insulin resistance (IR) as well as T2DM complications. Therefore this review focuses on the molecular mechanism of obesity induced inflammation, signaling pathways contributing to diabetes, as well as role of lifestyle interventions and medical therapies in the prevention and management of T2DM. Method Articles were searched on digital data base PubMed, Cochrane Library, and Web of Science. The key words used for search included Type 2 diabetes mellitus, obesity, insulin resistance, vascular inflammation and peripheral arterial disease. Result Visceral obesity is associated with chronic low grade inflammation and activation of immune systems which are involved in pathogenesis of obesity related IR and T2DM. Conclusion Metabolic dysregulation of adipose tissue leads to local hypoxia, misfolded/unfolded protein response and increased circulating free fatty acids, which in turn initiate inflammatory signaling cascades in the population of infiltrating cells. Mechanism that relates the role of adipocytokines with insulin sensitivity and glucose homeostasis might throw a light on the development of therapeutic interventions and subsequently might result in the reduction of vascular complications.
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Affiliation(s)
- Umashree Yadav
- Department of Physiology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh 221005 India
| | - Nilesh Kumar
- Department of General Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, 221005 India
| | - Kumar Sarvottam
- Department of Physiology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh 221005 India
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Paraskevas KI, Shearman CP. Ask the expert: assessment of peripheral vascular disease in primary care. BMJ 2023; 381:605. [PMID: 37160326 DOI: 10.1136/bmj.p605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
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Akinyosoye G, Akinola IJ, Lamina AB, Akinsola CM. Peripheral arterial disease among children with type 1 diabetes mellitus in a Nigerian teaching hospital. J Pediatr Endocrinol Metab 2023; 36:378-383. [PMID: 36935567 DOI: 10.1515/jpem-2022-0504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 01/18/2023] [Indexed: 03/21/2023]
Abstract
OBJECTIVES The study aimed to determine the prevalence of PAD in children with T1DM and to correlate PAD with clinical characteristics in children with T1DM. METHODS A comparative cross-sectional study was conducted involving 90 subjects (forty-five with T1DM and 45 apparently healthy comparative subjects that were matched for age and gender). Systolic blood pressure was measured in all limbs using the pocket Doppler machine (Norton Doppler scan machine). Ankle brachial index (ABI) was calculated as a ratio of ankle to arm systolic blood pressure. Peripheral arterial disease was defined as ABI less than 0.9. RESULTS The prevalence of PAD was significantly higher in children with T1DM than in the matched comparison group (37.8% vs. 6.7%, p<0.001). Average values of waist circumference, hip circumference, weight, height and body mass index were comparable in subjects with TIDM and the comparison group (p>0.05). Subjects with PAD had a poorer glucose control evident by higher average values of glycated haemoglobin than those without PAD (13.47 ± 3.2% vs. 8.16 ± 2.3%, p<0.001). There is a strong negative correlation between ABI scores and glycated haemoglobin among subjects with T1DM (r=-0.626, p<0.001). CONCLUSIONS With these findings, it is recommended that screening for PAD in children who have T1DM and poor glycaemic control should be done early to prevent cardiovascular complications before they arise.
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Affiliation(s)
- Gbenga Akinyosoye
- Department of Paediatrics, Lagos State University Teaching Hospital, Lagos, Nigeria
| | - Ibironke Jadesola Akinola
- Department of Paediatrics, Lagos State University Teaching Hospital, Lagos, Nigeria
- Department of Paediatrics and Child Health, Lagos State University College of Medicine, Lagos, Nigeria
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Li X, Yu J, Bai J, Huang H, Ying S, Wang A, Wang P. Interaction Between Obesity and Hypertension on Arteriosclerosis in Chinese Urban Adults: A Population-Based Cross-Sectional Study. Clin Nurs Res 2023; 32:629-638. [PMID: 36169279 DOI: 10.1177/10547738221120733] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study recruited 9,830 participants to identify whether the interaction between obesity and hypertension affects the occurrence of arteriosclerosis in Chinese adults. Brachial-ankle pulse wave velocity (baPWV) was measured to diagnose arteriosclerosis. Unconditional logistic regression was used for multiplicative interaction. The additive interaction was represented by relative excess risk due to interaction (RERI), attributable proportion (AP), and synergy (S). Hypertension was an independent risk factor for baPWV (p < .01), but obesity was not (p = .08). The interaction between obesity and hypertension on arteriosclerosis was not multiplicative (adjusted odds ratio = 0.89 (0.79-1.01), p = .07), but a negative additive interaction (RERI = -4.33, AP = -2.91, S = 0.10; p < .01) exists. Therefore, obesity may reduce the risk of arteriosclerosis caused by hypertension when hypertension and obesity coexist, especially in women and middle-aged people, which supports the obesity paradox.
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Affiliation(s)
- Xiaohan Li
- Faculty of Sport Science, Research Academy of Grand Health, Ningbo University, China
| | - Junwu Yu
- Ningbo Puyuanphysio Clinic, China.,Ningbo College of Health Sciences, China
| | | | - Huiming Huang
- Faculty of Sport Science, Research Academy of Grand Health, Ningbo University, China
| | - Shanshan Ying
- Faculty of Sport Science, Research Academy of Grand Health, Ningbo University, China
| | - Aiwen Wang
- Faculty of Sport Science, Research Academy of Grand Health, Ningbo University, China
| | - Ping Wang
- Lingnan Normal University, Zhanjiang, China
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Leslie R, May S, Scordis C, Isgar V, Poulton P, Garnham A. Outcomes following supervised exercise and home-based exercise for patients with intermittent claudication. JOURNAL OF VASCULAR NURSING 2022; 40:157-161. [PMID: 36435597 DOI: 10.1016/j.jvn.2022.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 09/16/2022] [Accepted: 09/19/2022] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Intermittent claudication (IC) is the most common symptom of peripheral arterial disease (PAD) which presents as a consequence of muscle ischaemia resulting from the atherosclerotic obstruction to arterial flow. High-quality evidence (Lane et al., 2017) shows that exercise programmes provide important benefits compared with usual care in improving pain-free and maximum walking distance in people with IC, but do not improve ankle-brachial pressure index (ABPI). METHODS Retrospective data were analysed to examine walking and ABPI outcomes for participants who completed a 12-week course of supervised or home-based exercise. All participants had a history of IC. RESULTS 46 participants (mean age 69±11 years; 76% male; 29% current smokers) referred for exercise were assessed, completed a 12-week course of exercise (home-based or supervised) and subsequently attended for re-assessment. Claudication onset distance (COD) increased by 363% (mean improvement 344.7 ± 265.1m; p < .001) and peak walking distance (PWD) by 324.4% in the supervised exercise group; COD increased by 30.6% (mean improvement 32.8 ± 57.2 m; p = 0.026) and PWD by 31.5% in the home-based exercise group. Resting ABPI for the total cohort significantly improved from 0.82 ± 0.25 at A1 to 0.88 ± 0.25 at A2 (p = 0.027). DISCUSSION A 12-week course of supervised exercise results in significantly greater walking distance outcomes (COD and PWD) than unmonitored home-based exercise. In contrast with previous findings (Lane et al. 2017), this retrospective study demonstrated a significant improvement in resting ABPI with both supervised exercise as well as home-based exercise. CONCLUSION A 12-week programme of exercise favourably influenced walking and ABPI outcomes for patients with IC. Both home-based exercise and supervised individualised exercise increased walking distances, but the magnitude of the improvement in walking outcomes was greater in individuals who attended supervised exercise therapy.
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Affiliation(s)
- R Leslie
- Chief Allied Health Professional, Royal Wolverhampton NHS Trust, New Cross Hospital, Wolverhampton WV10 0QP, United Kingdom.
| | - S May
- Exercise Physiologist Cardiac Rehabilitation, Royal Wolverhampton NHS Trust, United Kingdom
| | - C Scordis
- Specialist Exercise Physiologist Cardiac Rehabilitation, Royal Wolverhampton NHS Trust, United Kingdom
| | - V Isgar
- Clinical Nurse Specialist Vascular, Royal Wolverhampton NHS Trust, United Kingdom
| | - P Poulton
- Clinical Nurse Specialist Vascular, Royal Wolverhampton NHS Trust, United Kingdom
| | - A Garnham
- Vascular Surgeon, Royal Wolverhampton NHS Trust, United Kingdom
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The assessment of lower extremity peripheral artery disease impact on body mass center disorders. Clin Biomech (Bristol, Avon) 2022; 99:105742. [PMID: 36031704 DOI: 10.1016/j.clinbiomech.2022.105742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 08/07/2022] [Accepted: 08/12/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND Lower extremity peripheral artery disease is a problem of contemporary medicine and along with the ischemic heart disease it is considered to be a civilization disease. The risk of the disease increases significantly within a group of people reaching the age of 55 years and is closely related to co-occurring hazardous factors, such as diabetes, hyperlipidemia, hypertension or tobacco smoking. The first symptom reported by patients is intermittent claudication. Such symptoms may indicate that lower extremity peripheral artery disease does have an impact on posture disorders and motor skills. METHODS The study covered four stages. The first stage involved medical interviews to obtain information regarding anthropometry, age, motor organ surgery, concomitant diseases and the lifestyle. In the following stage the value of the ankle brachial index for both lower limbs were calculated. In case of symptomatic patients, additionally, the location of artery stenosis/aortoiliac section, was verified. The third stage involved using a dynamometric platform for determination of the body mass center position for both studied groups. In the fourth stage a treadmill walk test was used to assess the participants for intermittent claudication. FINDINGS Based on the obtained results, an attempt was taken to observe the relationship between the clinical characteristics of the disease and the body mass center position deviations. INTERPRETATION The attempt was undertaken to assess whether the measurement of body mass center position might be a diagnostic parameter to evaluate the patient's condition and thus an indication for taking a decision for surgical treatment or rehabilitation.
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de Silva NL, Athukorala T, Gamage JL, Katulanda G, de Silva P, Sumanatilleke M, Somasundaram N. Sexual dysfunction among men with diabetes; a cross-sectional study at a specialised diabetes clinic in Sri Lanka. BMC Endocr Disord 2022; 22:206. [PMID: 35978307 PMCID: PMC9382620 DOI: 10.1186/s12902-022-01108-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Accepted: 07/18/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Male sexual dysfunction in diabetes is often an unrevealed clinical issue. Though many publications report the prevalence, there is limited data on its associations, impact, and health-seeking behaviour. The objectives were to assess the prevalence of male sexual dysfunction, its associations, impact and treatment-seeking among men with diabetes in a selected tertiary care Diabetes Clinic. METHODS A cross-sectional study was conducted at the Diabetes Clinic, National Hospital of Sri Lanka, from January to September 2020. Men with diabetes aged 18 to 70 years undergoing annual assessment were recruited consecutively. Socio-demographic and clinical information were collected using an interviewer-administered questionnaire. Erectile dysfunction (ED), premature ejaculation, mental health and quality of life were assessed using validated self-administered questionnaires. Cardiovascular autonomic reflex tests and total testosterone levels were performed. Penile colour Doppler ultrasonography was performed on consenting participants with erectile dysfunction. Associations were assessed using the chi-square test or Fisher's exact for dichotomous variables and independent sample t-test for continuous variables. RESULTS Two hundred and twelve participants were recruited with a mean age of 54.1 (SD = 10.1) years. Erectile dysfunction was present in 168 (79.2%), (mild: 45, mild-moderate: 56, moderate: 26, severe: 41). Premature ejaculation was present in 26 (18.7%). Libido was low among 16%. Sexual dysfunction was not revealed to a health provider by 85.6% despite 60.5% experiencing psychological and/or relationship effects. Out of 18 who sought treatment, only 4 achieved a good response. Mean age (55.4 ± 9.5 vs 48.7 ± 10.6 years, p < 0.001) and duration of diabetes (10.9 ± 7.6 vs 5.8 ± 4.6 years, p < 0.001) were higher while eGFR was lower (73.9 ± 27.7 vs 100.51 ± 28.08 years, p < 0.008) among those with ED compared to those without. Diabetic retinopathy (4% vs 42%, p < 0.001), peripheral neuropathy (17.9% vs 38.4%, p = 0.041) and lower limb arterial disease (0% vs 12.2%, p = 0.04) were associated with ED. Arterial insufficiency was seen among 50% of the participants who underwent penile colour Doppler ultrasonography. CONCLUSIONS Male sexual dysfunction is a pervasive yet underappreciated problem in diabetes care despite its effect on the individual. Patient and disease characteristics would guide the identification of high-risk individuals for targeted screening in clinical practice.
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Affiliation(s)
- Nipun Lakshitha de Silva
- Department of Clinical Sciences, Faculty of Medicine, General Sir John Kotelawala Defence University, Colombo, Sri Lanka.
- Diabetes and Endocrine Unit, National Hospital of Sri Lanka, Colombo, Sri Lanka.
| | - Tharaka Athukorala
- Diabetes and Endocrine Unit, National Hospital of Sri Lanka, Colombo, Sri Lanka
| | | | - Gaya Katulanda
- Department of Chemical Pathology, National Hospital of Sri Lanka, Colombo, Sri Lanka
| | - Prasad de Silva
- Department of Radiology, National Hospital of Sri Lanka, Colombo, Sri Lanka
| | | | - Noel Somasundaram
- Diabetes and Endocrine Unit, National Hospital of Sri Lanka, Colombo, Sri Lanka
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Prevalence and determinants of peripheral arterial disease in children with nephrotic syndrome. PLoS One 2022; 17:e0266432. [PMID: 35951636 PMCID: PMC9371348 DOI: 10.1371/journal.pone.0266432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Accepted: 07/22/2022] [Indexed: 11/19/2022] Open
Abstract
Peripheral arterial disease (PAD) is the least studied complication of nephrotic syndrome (NS). Risk factors which predispose children with NS to developing PAD include hyperlipidaemia, hypertension and prolonged use of steroids. The development of PAD significantly increases the morbidity and mortality associated with NS as such children are prone to sudden cardiac death. The ankle brachial index (ABI) is a tool that has been proven to have high specificity and sensitivity in detecting PAD even in asymptomatic individuals. We aimed to determine the prevalence of PAD in children with NS and to identify risk factors that can independently predict its development. A comparative cross-sectional study was conducted involving 200 subjects (100 with NS and 100 apparently healthy comparative subjects that were matched for age, sex and socioeconomic class). Systolic blood pressures were measured in all limbs using the pocket Doppler machine (Norton Doppler scan machine). ABI was calculated as a ratio of ankle to arm systolic blood pressure. PAD was defined as ABI less than 0.9. The prevalence of PAD was significantly higher in children with NS than matched comparison group (44.0% vs 6.0%, p < 0.001). Average values of waist and hip circumference were significantly higher in subjects with PAD than those without PAD (61.68± 9.1cm and 67.6± 11.2 cm vs 57.03 ± 8.3cm and 65.60± 12.5cm respectively, p< 0.005). Serum lipids (triglyceride, very low density lipoprotein, total cholesterol and low density lipoprotein) were also significantly higher in subjects with PAD than those without PAD [106.65mg/dl (67.8–136.7) vs 45.72mg/dl (37.7–61.3), 21.33mg/dl (13.6–27.3) vs 9.14mg/dl (7.5–12.3), 164.43mg/dl (136.1–259.6) vs 120.72mg/dl (111.1–142.1) and 93.29mg/dl (63.5–157.3) vs 61.84mg/dl (32.6–83.1), respectively p< 0.05]. Increasing duration since diagnosis of NS, having a steroid resistant NS and increasing cumulative steroid dose were independent predictors of PAD in children with NS; p< 0.05 respectively. With these findings, it is recommended that screening for PAD in children with NS should be done to prevent cardiovascular complications before they arise.
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Zheng Y, Du X, Yin L, Liu H. Effect of electrical stimulation on patients with diabetes-related ulcers: a systematic review and meta-analysis. BMC Endocr Disord 2022; 22:112. [PMID: 35477391 PMCID: PMC9044601 DOI: 10.1186/s12902-022-01029-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 04/20/2022] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND This study aimed to systematically review the literature to better understand the efficacy of electrical stimulation (ES) for the treatment of patients with diabetes-related ulcers. METHODS We searched the Embase, Medline, and Cochrane Library databases through July 31, 2021. Original trials for ES treatment of patients with diabetes-related ulcers with placebo or standard care as the control group were included. The primary outcomes were ulcer area reduction and healing rates. Meta-analyses were performed to compare the standardized mean difference (SMD) in the percentage of ulcer reduction and risk ratio of non-healing rates between ES treatment and placebo or standard care. We used the Revised Cochrane risk-of-bias tool for randomized trials to assess the risk of bias for each included article. Funnel plots and Egger's test were used to assess publication bias. RESULTS Compared to placebo or standard care, ES had a significant benefit for the treatment of patients with diabetes-related ulcers in terms of percentage of ulcer reduction (SMD = 2.56, 95% CI: 1.43-3.69; P < 0.001 (Q-test), I2 = 93.9%) and ulcer healing rates [risk ratio of non-healing rates for the ES group was 0.72 (95% CI: 0.54-0.96; P = 0.38 (Q-test), I2 = 2.3%)]. Two, four, and three of the included studies were categorized into low risk of bias, some concerns, and high risk of bias, respectively. No publication bias was found. CONCLUSIONS Based on the findings of this meta-analysis, ES could be used to treat patients with diabetes-related ulcers. ES treatment was effective for ulcer area reduction and ulcer healing, although it had a high heterogeneity level among the included studies. Pulsed current ES has the potential benefit of increasing ulcer healing compared to direct current ES. Further large-scale clinical trials are needed to define the adverse events and potentiators of ES in the treatment of patients with diabetes-related ulcers.
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Affiliation(s)
- Yinhua Zheng
- Department of Rehabilitation Medicine, The First Hospital of Jilin University, No.1, Xinmin Street, Chang Chun, 130021, Jilin Province, China.
| | - Xue Du
- Department of Clinical Laboratory Medicine, Affiliated Hospital, Changchun University of Chinese Medicine, Changchun, 130021, China
| | - Liquan Yin
- Department of Rehabilitation Medicine, The Third Hospital of Jilin University, Changchun, 130033, China
| | - Hongying Liu
- Department of Rehabilitation Medicine, The First Hospital of Jilin University, No.1, Xinmin Street, Chang Chun, 130021, Jilin Province, China
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Huthart S, Oates C, Allen J, Fiaschi K, Sims AJ, Stansby G. Validation of a Standardised Duplex Ultrasound Classification System for the Reporting and Grading of Peripheral Arterial Disease. Eur J Vasc Endovasc Surg 2022; 64:210-216. [PMID: 35472448 DOI: 10.1016/j.ejvs.2022.04.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 02/20/2022] [Accepted: 04/18/2022] [Indexed: 11/03/2022]
Abstract
INTRODUCTION Duplex ultrasound (DUS), a non-invasive means of arterial mapping, allows for reliable diagnosis of peripheral arterial disease (PAD). One of our authors (CPO), developed a standardised DUS-based scoring system, devised for rapid detection and reporting of PAD. The purpose of this study is to validate this system, determining diagnostic performance both overall, and per disease severity. METHODS 250 participants were recruited, based on diagnosis (N = 125), or absence of PAD (N = 125) from GP registers. Right and left legs per subject were handled as independent readings, determining actual PAD status via ABPI <0.9, and then further grading disease severity using suggested ABPI ranges. Data were excluded if no corresponding ABPI value was obtained per DUS-determination, or if the ABPI reading was >1.4, owing to risk of false negatives due to incompressible vessels. Diagnostic sensitivity and specificity were obtained overall, and per severity classification. Furthermore, interrater agreement between ABPI- and DUS-determined PAD severity was determined by linear weighted Cohen's Kappa. RESULTS The sensitivity and specificity in the detection of disease overall was 81.0% (95% CI 73.4 - 87.2%) and 86.3% (95% CI 82.3 - 89.8%), respectively. From mild to severe PAD, sensitivity increased from 71.1% (95% CI 55.7 - 83.6%) to 89.3% (95% CI 71.8 - 97.7%). Furthermore, a Cohen Kappa value of 0.63 (95% CI 0.57 - 0.69) was obtained, indicating moderate agreement between the two diagnostic methods. CONCLUSIONS Findings in this study validate the diagnostic performance of the standardised DUS scoring system, as well as its capacity to grade severity of disease, offering a potential tool for the identification of PAD in the community / research settings following initial screening methods. Confirmatory work could include a comparison of DUS-determined disease with gold-standard methods of non-invasive angiography, and novel tools such as toe-flex NIRS and multi-site photoplethysmography.
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Affiliation(s)
- Samuel Huthart
- Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, NE2 4HH, UK; Northern Medical Physics and Clinical Engineering Department, Freeman Hospital, Newcastle Upon Tyne, NE7 7DN, UK; Northern Vascular Centre, Freeman Hospital, Newcastle upon Tyne, NE7 7DN, UK.
| | - Crispian Oates
- Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, NE2 4HH, UK; Northern Medical Physics and Clinical Engineering Department, Freeman Hospital, Newcastle Upon Tyne, NE7 7DN, UK
| | - John Allen
- Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, NE2 4HH, UK; Northern Medical Physics and Clinical Engineering Department, Freeman Hospital, Newcastle Upon Tyne, NE7 7DN, UK; Research Centre for Intelligent Healthcare, Coventry University, Coventry, CV1 5RW, UK
| | - Kathia Fiaschi
- Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, NE2 4HH, UK; Northern Medical Physics and Clinical Engineering Department, Freeman Hospital, Newcastle Upon Tyne, NE7 7DN, UK; Northern Vascular Centre, Freeman Hospital, Newcastle upon Tyne, NE7 7DN, UK
| | - Andrew J Sims
- Northern Medical Physics and Clinical Engineering Department, Freeman Hospital, Newcastle Upon Tyne, NE7 7DN, UK
| | - Gerard Stansby
- Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, NE2 4HH, UK; Northern Medical Physics and Clinical Engineering Department, Freeman Hospital, Newcastle Upon Tyne, NE7 7DN, UK
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Khadoura KJ, Kahlout A, Habib MH. Nontraditional risk factors of coronary artery disease among Palestinians: A case-control study. JOURNAL OF VASCULAR NURSING 2022; 40:35-42. [DOI: 10.1016/j.jvn.2021.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 10/09/2021] [Indexed: 10/19/2022]
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Correlation between the ankle-brachial index and microalbuminuria with certain risk factors in type 2 diabetes patients. Cardiovasc Endocrinol Metab 2021; 10:210-214. [PMID: 34765891 PMCID: PMC8575440 DOI: 10.1097/xce.0000000000000251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 03/25/2021] [Indexed: 11/26/2022]
Abstract
The ankle-brachial index (ABI) is a fast, simple, noninvasive method that provides accurate results in the early diagnosis of peripheral artery disease. Microalbuminuria is considered a predictor of renal and cardiovascular complications in patients with diabetes. This study was conducted to determine the correlation between ABI and microalbuminuria with certain risk factors in patients with type 2 diabetes. Subjects and research methods A cross-sectional descriptive study was performed on 62 inpatients with type 2 diabetes. All patients were measured for ABI as well as microalbuminuria, HbA1c, glucose and lipidemia in the blood. Results The study results showed that in patients with dyslipidemia, the risk of having microalbuminuria (+) increased 5.7 times and ABI ≤0.90 increased 8.6 times (P = 0.004 and 0.021, respectively). Fasting blood glucose >7.2 mmol/L had 5.7 times higher microalbuminuria (+) risk and 8.6 times higher ABI ≤0.90 (P = 0.004 and 0.021, respectively). Patients with HbA1c ≥7% were 2.9 times more likely to have microalbuminuria (+) and ABI ≤0.90 (P = 0.043 and 0.048, respectively). Conclusions Peripheral vascular disease risk factors such as hypertension, dyslipidemia and waist circumference and the effectiveness of fasting blood glucose and HbA1c control increased the risk of high microalbuminuria and ABI in patients with type 2 diabetes.
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Ding T, Lloyd H. Perceptions of primary care and hospital clinicians on the use of the Ankle Brachial Pressure Index in general practice. J Prim Health Care 2021; 13:165-170. [PMID: 34620298 DOI: 10.1071/hc20057] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 03/11/2021] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Peripheral arterial disease is an increasingly prevalent chronic illness globally. The Ankle Brachial Pressure Index (ABPI) is a well-established, simple, relatively quick and non-invasive assessment useful in diagnosing and quantifying peripheral arterial disease. ABPIs may be currently underutilised in general practice. AIM To explore perspectives of health professionals on the role of the ABPI. METHODS One-to-one interviews were conducted with health professionals using snowball sampling. Questions centred around interviewees' education on, experience with and view on the usefulness of the ABPI in general practice. Interviews were recorded and used for thematic analysis. RESULTS Participants consisted of 13 health-care professionals: nine general practitioners, two vascular surgeons and two allied health professionals. Most general practitioners interviewed identified benefits of ABPIs use in primary care, including aiding peripheral arterial disease diagnostics, management, referral and triage. No general practitioners stated they had ever had formal training in undertaking ABPIs. Two of the nine general practitioners stated regular ABPI use in their practice. Participants who did not use ABPIs identified practical barriers to its use in general practice, including cost of equipment, length of time needed and perceived low patient need to justify cost. All interviewees agreed that there was a role for ABPI use in the community if barriers were overcome. DISCUSSION There was consensus among general practitioners that ABPI use is beneficial. Many general practitioners named similar practical barriers to more common use of ABPIs in general practice. They saw a role for ABPIs in primary care, although it may be more practical as a tool for specialised individual clinicians to use for communities, given practical barriers of cost, time and perceived low patient need. Formal training could be considered, as none of the interviewed general practitioners had ever had any.
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Affiliation(s)
- Thomas Ding
- Primary and Community Care, Southern DHB, Mosgiel Health Centre, New Zealand; and Corresponding author.
| | - Hywel Lloyd
- Department of General Practice and Rural Health, University of Dunedin, Otago, New Zealand
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Poredos P, Boc V, Zlajpah U, Mangaroska AS, Poredos P. Walking Impairment Questionnaire and Walking Tests are Reliable Indicators of Success of Treatment of Peripheral Artery Disease. Angiology 2021; 73:331-337. [PMID: 34551598 DOI: 10.1177/00033197211045281] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The functional capacity of patients with peripheral arterial disease (PAD) represents an important indicator of patient health and quality of life. The aim of this prospective study was to investigate the validity of a walking impairment questionnaire (WIQ) compared with walking tests for the estimation of the therapeutic effect of lower limb revascularization. The study included 36 patients with PAD in whom successful percutaneous revascularization of a lower limb was performed due to disabling intermittent claudication. Before the revascularization procedure and 4-6 weeks after successful revascularization, clinical examination, ankle brachial index (ABI) measurement, 6-min walk test, treadmill test, and WIQ were performed. After revascularization, significant improvement in walking capacity was shown by both 6-min walk test and treadmill exercise test as well as with WIQ. However, the increase in ABI was borderline. Significant correlations between improvement of 6-min walk test and treadmill exercise test results and the sum of WIQ points were found. The ABI was significantly correlated with treadmill maximal walking distance only. According to our results, the WIQ correlates well with walking tests and is a reliable indicator of effective revascularization of lower limb arterial occlusions, even in patients with a nonsignificant improvement of the ABI.
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Affiliation(s)
- Pavel Poredos
- Clinical Department of Vascular Diseases, 364687University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Vinko Boc
- Clinical Department of Vascular Diseases, 364687University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Urska Zlajpah
- Clinical Department of Vascular Diseases, 364687University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Ana Spirkoska Mangaroska
- Clinical Department of Vascular Diseases, 364687University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Peter Poredos
- Clinical Department of Anesthesiology and Intensive Care, University Medical Centre Ljubljana, Ljubljana, Slovenia
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Alagha M, Aherne TM, Hassanin A, Zafar AS, Joyce DP, Mahmood W, Tubassam M, Walsh SR. Diagnostic Performance of Ankle-Brachial Pressure Index in Lower Extremity Arterial Disease. Surg J (N Y) 2021; 7:e132-e137. [PMID: 34295970 PMCID: PMC8289682 DOI: 10.1055/s-0041-1731444] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 05/17/2021] [Indexed: 11/24/2022] Open
Abstract
Introduction
Ankle-brachial pressure indices (ABIs) continue to form the basis of diagnostics for lower extremity arterial disease (LEAD). However, there remains a paucity of data to support its accuracy. This study aims to evaluate its diagnostic sensitivity and specificity using established arterial-imaging modalities as a benchmark.
Methods
In this retrospective study, a regional, prospectively maintained, vascular laboratory database was interrogated to identify referred patients with arterial disease who underwent concomitant assessment with ABI and lower limb arterial duplex ultrasound (DUS). Duplex acted as the reference standard. Those who had peripheral computed tomography angiogram (CTA) within 3 months of initial assessment were included in a subgroup analysis to correlate ABI with CTA. The primary end point was the sensitivity and specificity of ABI compared with DUS as the reference standard.
Results
Concomitant assessment was performed in 438 limbs (250 patients) over a 27-month period. The ABI was normal (0.9 to 1.4) in 196 limbs (44.9%) and abnormal in the remaining 241 limbs (55.1%). False-positive results occurred in 83 out of 241 limbs (34.4%), and false-negative results occurred in 54 limbs out of 196 (27.5%). True-positive results were 158 out of 241 limbs (65.6%), whereas true-negative results were 142 out of 196 limbs (72.4%). ABI using DUS as a benchmark identified a sensitivity for peripheral artery disease of 72.3% and a specificity of 69.3%. Concomitant CTA imaging was available in 200 limbs. The sensitivity and specificity of ABI correlated with CTA were 65.5 and 68.8%, respectively.
Conclusion
ABIs have a moderate predictive value in the diagnosis of LEAD. Normal range outcomes cannot be taken to infer the absence of LEAD and, as such, further arterial imaging in the form of DUS or angiography should be strongly considered in those with suspected underlying disease requiring intervention. Further noninvasive tests such as exercise studies or pulse volume waveforms should be considered, if diagnostic uncertainty exists, in those requiring nonoperative intervention and risk factor control.
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Affiliation(s)
- Mohammed Alagha
- Discipline of Vascular Surgery, National University of Ireland, Galway, Ireland
| | - Thomas M Aherne
- Discipline of Vascular Surgery, National University of Ireland, Galway, Ireland
| | - Ahmed Hassanin
- Discipline of Vascular Surgery, National University of Ireland, Galway, Ireland
| | - Adeel S Zafar
- Discipline of Vascular Surgery, National University of Ireland, Galway, Ireland
| | - Doireann P Joyce
- Discipline of Vascular Surgery, National University of Ireland, Galway, Ireland
| | - Waqas Mahmood
- Discipline of Vascular Surgery, National University of Ireland, Galway, Ireland
| | - Muhammad Tubassam
- Discipline of Vascular Surgery, National University of Ireland, Galway, Ireland
| | - Stewart R Walsh
- Discipline of Vascular Surgery, National University of Ireland, Galway, Ireland
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Kyle D, Boylan L, Wilson L, Haining S, Oates C, Sims A, Guri I, Allen J, Wilkes S, Stansby G. Accuracy of Peripheral Arterial Disease Registers in UK General Practice: Case-Control Study. J Prim Care Community Health 2021; 11:2150132720946148. [PMID: 32959726 PMCID: PMC7513392 DOI: 10.1177/2150132720946148] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Background: Approximately 20% of the UK population aged 55 to 75 years have evidence of
peripheral arterial disease (PAD). PAD affects quality of life and life
expectancy if not appropriately diagnosed and managed. At risk patients
require accurate diagnosis to ensure optimal treatment to slow disease
progression and minimize adverse outcomes. Aim: To assess the accuracy of general practice (GP) registration of the diagnosis
of peripheral arterial disease (PAD). Design and Setting: An observational analytic case-control study. As part of a National Institute
for Health Research–funded (ISRCTN13301188) project assessing novel
diagnostic methods set in GP practice. Methods: A total of 125 patients registered as having PAD and 125 age- and sex-matched
controls were recruited from 15 general practices across North East England.
The register was then assessed for accuracy of diagnosis. Duplex vascular
ultrasound scanning (DUS) undertaken by vascular scientists was used as the
gold standard reference for PAD. Results: The PAD register had a sensitivity of 86% (95% CI 77%-92%) and specificity of
74% (95% CI 67%-81%) when compared with DUS. The positive predictive value,
however, was 69.6% (95% CI 63%-75%) and negative predictive value 88.8% (95%
CI 82%-92%). The overall diagnostic effectiveness of the PAD register was
79.2% (95% CI 73%-84%). Conclusion: This analysis indicates that while PAD is detected with reasonable
sensitivity in primary care, many patients registered with a diagnosis of
PAD lacked DUS-proven disease. Improved approaches to the objective
diagnosis of PAD may improve diagnosis and management of PAD in primary
care.
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Affiliation(s)
- Daniel Kyle
- Freeman Hospital, The Newcastle upon Tyne NHS Hospitals Foundation Trust, Newcastle upon Tyne, UK.,University of Newcastle, Newcastle upon Tyne, UK
| | - Luke Boylan
- Freeman Hospital, The Newcastle upon Tyne NHS Hospitals Foundation Trust, Newcastle upon Tyne, UK.,University of Newcastle, Newcastle upon Tyne, UK
| | - Lesley Wilson
- Freeman Hospital, The Newcastle upon Tyne NHS Hospitals Foundation Trust, Newcastle upon Tyne, UK
| | - Shona Haining
- North of England Commissioning Support (NECS), Durham, UK
| | - Crispian Oates
- Freeman Hospital, The Newcastle upon Tyne NHS Hospitals Foundation Trust, Newcastle upon Tyne, UK
| | - Andrew Sims
- Freeman Hospital, The Newcastle upon Tyne NHS Hospitals Foundation Trust, Newcastle upon Tyne, UK.,University of Newcastle, Newcastle upon Tyne, UK
| | - Ina Guri
- Freeman Hospital, The Newcastle upon Tyne NHS Hospitals Foundation Trust, Newcastle upon Tyne, UK.,University of Newcastle, Newcastle upon Tyne, UK
| | - John Allen
- Freeman Hospital, The Newcastle upon Tyne NHS Hospitals Foundation Trust, Newcastle upon Tyne, UK.,University of Newcastle, Newcastle upon Tyne, UK
| | - Scott Wilkes
- University of Sunderland, Sunderland, Tyne and Wear, UK
| | - Gerry Stansby
- Freeman Hospital, The Newcastle upon Tyne NHS Hospitals Foundation Trust, Newcastle upon Tyne, UK
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Subramanian N, Han J, Leeper NJ, Ross EG, Montez-Rath ME, Chang TI. Comparison of Pre-Amputation Evaluation in Patients with and without Chronic Kidney Disease. Am J Nephrol 2021; 52:388-395. [PMID: 33957619 PMCID: PMC8278981 DOI: 10.1159/000516017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 03/11/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Patients with chronic kidney disease (CKD) and peripheral artery disease (PAD) are more likely to undergo lower extremity amputation than patients with preserved kidney function. We sought to determine whether patients with CKD were less likely to receive pre-amputation care in the 1-year prior to lower extremity amputation compared to patients without CKD. METHODS We conducted a retrospective observational study of patients with PAD-related lower extremity amputation between January 2014 and December 2017 using a large commercial insurance database. The primary exposure was CKD identified using billing codes and laboratory values. The primary outcomes were receipt of pre-amputation care, defined as diagnostic evaluation (ankle-brachial index, duplex ultrasound, and computed tomographic angiography), specialty care (vascular surgery, cardiology, orthopedic surgery, and podiatry), and lower extremity revascularization in the 1-year prior to amputation. We conducted separate logistic regression models to estimate the adjusted odds ratio (aOR) and 95% confidence intervals (CIs) among patients with and without CKD. We assessed for effect modification by age, sex, Black race, and diabetes status. RESULTS We identified 8,554 patients with PAD-related amputation. In fully adjusted models, patients with CKD were more likely to receive diagnostic evaluation (aOR 1.30; 95% CI 1.17-1.44) and specialty care (aOR 1.45, 95% CI 1.27-1.64) in the 1-year prior to amputation. There was no difference in odds of revascularization by CKD status (aOR 1.03, 0.90-1.19). Age, sex, Black race, and diabetes status did not modify these associations. DISCUSSION/CONCLUSION Patients with CKD had higher odds of receiving diagnostic testing and specialty care and similar odds of lower extremity revascularization in the 1-year prior to amputation than patients without CKD. Disparities in access to pre-amputation care do not appear to explain the higher amputation rates seen among patients with CKD.
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Affiliation(s)
- Nivetha Subramanian
- Department of Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Jialin Han
- Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Nicholas J. Leeper
- Division of Vascular Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Elsie G. Ross
- Division of Vascular Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, California, USA
- Center for Biomedical Informatics Research, Stanford University School of Medicine, Stanford, California, USA
| | - Maria E. Montez-Rath
- Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Tara I. Chang
- Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Stanford, California, USA
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25
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Dawczynski C, Cullen PM, Schlattmann P, Lorkowski S. A study protocol of a randomized trial evaluating the effect of using defined menu plans within an intensive personal nutritional counseling program on cardiovascular risk factors: The MoKaRi (modulation of cardiovascular risk factors) trial. Contemp Clin Trials Commun 2021; 22:100761. [PMID: 33997459 PMCID: PMC8105630 DOI: 10.1016/j.conctc.2021.100761] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Revised: 02/16/2021] [Accepted: 03/11/2021] [Indexed: 10/27/2022] Open
Abstract
Importance Changes in dietary habits and lifestyle can reduce the risk of cardiovascular disease which is the leading cause of death worldwide. Objectives of the MoKaRi study The MoKaRi (modulation of cardiovascular risk factors) intervention study is designed to evaluate the effectiveness and potential of the developed MoKaRi concept. The MoKaRi concept comprises three components, each designed to improve dietary behavior. The first component entails using daily menu plans to implement a defined "cardioprotective diet". This diet consists of seasonal menu plans which are characterized by:(i) a personalized energy supply depending on his or her age, gender, level of physical activity.(ii) an adequate intake of carbohydrates, protein, fat, vitamins, minerals, and trace elements according to the guidelines of the German Society of Nutrition (DGE).(iii) a recommended intake of saturated fatty acids (SFA; < 7% of caloric intake (En%)), monounsaturated fatty acids (MUFA; > 10 En%), polyunsaturated fatty acids.(PUFA; approx. 10 En%), and long-chain n-3 PUFA (≥500 mg per day).(iv) measures to encourage consumption of vegetables and fruits, and.(v) eating more than 40 g dietary fiber every day.Half of the participants will be scheduled to consume an additional 3 g of long-chain n- 3 PUFA every day in the form of fish oil.The second component consists of regular one-on-one nutritional counseling, while a variety of further incentives make up the third component of the MoKaRi concept.The MoKaRi study will provide essential insights into the relationship between defined nutrient intake, markers of food intake and health status. Our specific aim is to investigate the influence of dietary and lifestyle choices have on cardiovascular health.The information and practical tools suitable for daily use, such as the personalized menu plans, could help to transfer knowledge on nutritional facts to the general population. In this way, the validated MoKaRi concept may contribute to the prevention and therapy of cardiovascular diseases. Methods In line with our power calculation, we will enroll 60 participants and randomly assign them to one of two parallel arms. Each participant will receive personalized menu plans for each day of the study and will be provided with one-on-one nutritional counseling sessions every two weeks for a study period of 20 weeks (140 days). During this period, blood samples will be taken every 14 days (11 time points) and twice during a 20-weeks follow-up period. Incentives such as a supply of foods approved according t the standards of the study, a sports program, individual feedback on study parameters reflecting health status, and group activities round off the MoKaRi concept.Low-density cholesterol is the primary outcome measure of the MoKaRi study, and the secondary endpoints comprise markers of nutrient status (e.g. fatty acid distribution in plasma and erythrocyte lipids), a metabolomic profiling, diabetes risk markers, clotting markers, and further cardiovascular risk factors, such as blood lipids, homocysteine and high-sensitive c-reactive protein.The MoKaRi study was registered before launch at ClinicalTrials.gov (identifier NCT02637778; https://clinicaltrials.gov/ct2/show/NCT02637778).
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Affiliation(s)
- Christine Dawczynski
- Research Group Nutritional Concepts, Institute of Nutritional Sciences, Friedrich Schiller University Jena, Dornburger Str. 29, 07743, Jena, Germany.,Competence Cluster for Nutrition and Cardiovascular Health (nutriCARD) Halle-Jena-Leipzig, Dornburger Str. 25, 07743, Jena, Germany
| | - Paul M Cullen
- MVZ Labor Münster Dr. Löer, Prof. Cullen und Kollegen, Hafenweg 11, 48155, Münster, Germany
| | - Peter Schlattmann
- Competence Cluster for Nutrition and Cardiovascular Health (nutriCARD) Halle-Jena-Leipzig, Dornburger Str. 25, 07743, Jena, Germany.,Department of Medical Statistics, Informatics and Documentation, Jena University Hospital, Bachstr. 18, 07743, Jena, Germany
| | - Stefan Lorkowski
- Competence Cluster for Nutrition and Cardiovascular Health (nutriCARD) Halle-Jena-Leipzig, Dornburger Str. 25, 07743, Jena, Germany.,Department of Nutritional Biochemistry and Physiology, Institute of Nutritional Sciences, Friedrich Schiller University Jena, Dornburger Str. 25, 07743, Jena, Germany
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26
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Sag SJM, Strack C, Zeller J, Mohr M, Loew T, Lahmann C, Maier LS, Fischer M, Baessler A. Successful weight loss reduces endothelial activation in individuals with severe obesity participating in a multimodal weight loss program. Obes Res Clin Pract 2021; 15:249-255. [PMID: 33849799 DOI: 10.1016/j.orcp.2021.03.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 03/14/2021] [Accepted: 03/28/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Endothelial dysfunction is a very common finding in obesity and metabolic syndrome. The aim of our study was to investigate if longterm weight reduction (WR) success may reverse endothelial activation in individuals with severe obesity participating in a multimodal WR program. METHODS Participants with obesity (øBMI 40.3 ±7.5 kg/m2) underwent a standardized non-surgical 1-year WR program. Carotid artery studies and determination of endothelial function biomarkers were performed at baseline and after 1 year. Individuals were dichotomized in "successful WR" (% WR≥10% of initial body weight) and "failed WR" (% WR<10% of initial body weight). RESULTS From 191 people with obesity, 115 achieved successful WR. Compared to controls without obesity (n=44) participants with obesity had higher carotid intima media thickness as well as higher sICAM-1, sE-selectin, MMP-9, hsCRP and IL-6 levels. After 12 months follow up delta values of inflammation and endothelial adhesion markers were significantly different between participants with obesity and successful WR and participants with obesity and failed WR, in favour of the successful WR group (mean ± standard deviation): ΔhsCRP (-5.2 mg/L ±7.8 vs. 1.1 mg/L ±5.1, P<0.001; Padj=0.009), ΔIL-6 (-1.0 pg/mL ±3.4 vs. 0.5 pg/mL ±2.6, P<0.001; Padj=0.057), ΔsE-selectin (-19.0 ng/mL ±24.4 vs. 39.2 ng/mL ±20.3, P<0.001; Padj<0.001), ΔsICAM-1 (-26.4 ng/mL ±68.8 vs. 10.6 ng/mL ±73.9, P=0.004; Padj=0.805) and ΔoxLDL (-4 mg/dL ±30 vs. 5 mg/dL ±25, P=0.004; Padj=0.473). In linear regression analysis reduction of BMI was significantly associated with improvement of several endothelial dysfunction biomarkers with the strongest effects for ΔsE-selectin and ΔhsCRP. CONCLUSION Our data corroborate the finding that obesity leads to endothelial dysfunction. Furthermore, successful non-surgical WR may at least partially reverse endothelial activation implicating cardiovascular health benefits of WR in people with severe obesity.
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Affiliation(s)
- Sabine J M Sag
- Clinic for Internal Medicine II, University Hospital of Regensburg, Franz-Josef-Strauss Allee 11, 93053 Regensburg, Germany
| | - Christina Strack
- Clinic for Internal Medicine II, University Hospital of Regensburg, Franz-Josef-Strauss Allee 11, 93053 Regensburg, Germany
| | - Judith Zeller
- Clinic for Internal Medicine II, University Hospital of Regensburg, Franz-Josef-Strauss Allee 11, 93053 Regensburg, Germany
| | - Margareta Mohr
- Clinic for Internal Medicine II, University Hospital of Regensburg, Franz-Josef-Strauss Allee 11, 93053 Regensburg, Germany
| | - Thomas Loew
- Department of Psychosomatics, University Hospital of Regensburg, Franz-Josef-Strauss Allee 11, 93053 Regensburg, Germany
| | - Claas Lahmann
- Department of Psychosomatic Medicine und Psychotherapy, Center for Mental Health, Faculty of Medicine, University of Freiburg, Hauptstraße 8, D-79104 Freiburg, Germany
| | - Lars S Maier
- Clinic for Internal Medicine II, University Hospital of Regensburg, Franz-Josef-Strauss Allee 11, 93053 Regensburg, Germany
| | - Marcus Fischer
- Clinic for Internal Medicine II, University Hospital of Regensburg, Franz-Josef-Strauss Allee 11, 93053 Regensburg, Germany
| | - Andrea Baessler
- Clinic for Internal Medicine II, University Hospital of Regensburg, Franz-Josef-Strauss Allee 11, 93053 Regensburg, Germany.
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Lim SLX, Chung RE, Holloway S, Harding KG. Modified compression therapy in mixed arterial-venous leg ulcers: An integrative review. Int Wound J 2021; 18:822-842. [PMID: 33738975 PMCID: PMC8613381 DOI: 10.1111/iwj.13585] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 03/01/2021] [Accepted: 03/04/2021] [Indexed: 01/21/2023] Open
Abstract
Leg ulcers remain an increased burden to healthcare cost and morbidity in modern society. While most leg ulcers are venous in origin, recognition and prompt identification of concomitant arterial occlusive disease is critical to determine underlying aetiology and subsequent management. This integrative review presents the current evidence to establish the role of modified compression therapy (MCT) in treatment of mixed arterial venous leg ulcers (MAVLU). A literature search was conducted using the electronic databases CINAHL, MEDLINE, PUBMED, and Embase. Ten studies met the eligibility criteria and were subsequently analysed. Our review concludes that MCT, with compression pressures between 20 and 30 mmHg, can promote healing in MAVLU with moderate arterial insufficiency (0.5 ≤ ABPI ≤0.8). If ABPI is <0.5, MCT can be considered once restoration of acceptable ABPI is achieved. Intolerance, lack of response or further deterioration of disease within 3 months should prompt further arterial imaging and intervention. MCT is generally well tolerated with no adverse outcomes reported. A holistic yet individualised approach is vital in order to account for all factors influencing this patient-led decision-making process, ultimately ensuring effective treatment, which improves patient's quality of life and reduces socioeconomic burden of the disease.
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Affiliation(s)
- Sheryl Li Xin Lim
- Blackpool Victoria Hospital, Blackpool Teaching Hospitals, Blackpool, UK
| | - Rui En Chung
- Royal Stoke University Hospital, University Hospital North Midlands, Stoke-on-Trent, UK
| | | | - Keith G Harding
- FRCS Wound Healing Research Unit, Cardiff University, Cardiff, UK
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28
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Poredos P, Zlajpah U, Poredos P, Mangaroska AS, Jezovnik MK. Use of the walking impairment questionnaire as a measure of functional assessment. VASA 2021; 50:286-293. [PMID: 33661020 DOI: 10.1024/0301-1526/a000941] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Background: A significant consequence of peripheral arterial disease (PAD) is an impaired functional capacity and deteriorated quality of life. Therefore, our study aimed to investigate the usefulness of a symptom questionnaire and walk tests for the determination of the functional capacity of patients with intermittent claudication. Patients and methods: The study included 53 patients (38 males) with stable claudication distance (50-300m). A detailed history and physical examination, ankle-brachial index (ABI), treadmill exercise test, and 6-minute walk test were performed and compared to walking impairment questionnaire (WIQ). Results: Claudication distance reported from patients' history and 6-minute walk test were significantly correlated with ABI (p=0.033, p=0.044). There were no significant correlations between ABI and treadmill walk test or WIQ. Results of WIQ were significantly correlated with the history and the most of performed walk tests: treadmill initial and maximal claudication distance (p=0.004 and 0.012, respectively) and 6-minute walk test (p=0.026). 6-minute walk test was correlated with maximal claudication distance of treadmill (p=0.018), but not with an initial claudication distance. Conclusions: The validity of WIQ is comparable to walk tests and represents the useful technique for the investigation of the functional capacity of patients with PAD. A self-report based on WIQ enables a longer period of observation. It should be routinely used as a basic diagnostic tool for the estimation of the functional capacity of PAD patients with stable intermittent claudication.
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Affiliation(s)
- Pavel Poredos
- Department of Vascular Disease, University Medical Center Ljubljana, Slovenia.,Department of Advanced Cardiopulmonary Therapies and Transplantation, The University of Texas Health Science Center at Houston, Texas, USA
| | - Urska Zlajpah
- Department of Vascular Disease, University Medical Center Ljubljana, Slovenia
| | - Peter Poredos
- Department of Anesthesiology and Intensive Care, University Medical Center Ljubljana, Slovenia
| | | | - Mateja K Jezovnik
- Department of Advanced Cardiopulmonary Therapies and Transplantation, The University of Texas Health Science Center at Houston, Texas, USA
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29
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Abdel-Galeel A, El-Zokaim A, Hasan-Ali H, Ibrahim A, Ibrahim A, Ghaleb R. Low Ankle-Brachial Index is Associated with Microvascular Coronary Obstruction After Primary PCI. Vasc Health Risk Manag 2021; 17:23-32. [PMID: 33564236 PMCID: PMC7866912 DOI: 10.2147/vhrm.s291658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 01/20/2021] [Indexed: 11/23/2022] Open
Abstract
Introduction Percutaneous coronary intervention (PCI) has improved recanalization of infarct-related arteries (IRA); however, TIMI-III flow does not always mean an efficient myocardial reperfusion. Myocardial blush grade (MBG) is used as a predictor for coronary microvascular obstruction. We assessed the association between ankle-brachial index (ABI), a widely used method for diagnosis of peripheral arterial disease (PAD), and coronary microvascular obstruction (MVO) as detected by MBG after primary PCI. Patients and Methods The study included 335 patients with ST-elevation myocardial infarction who had primary PCI. History taking, clinical examination, laboratory assessment, ECG and Echocardiography were done for every participant. MBG was assessed for patients after PCI procedure. ABI for all participating patients was calculated. Results Two hundred and sixty-one patients fulfilled the inclusion criteria with mean age 58.8 ± 10.7 years, 84% were males. Sixty-one percent had anterior wall myocardial infarction. After primary PCI, despite achieving TIMI flow III in all study patients, only 37% had normal MBG. There was a statistically significant relationship between MBG and site of infarction, left ventricular ejection fraction and ABI. Low ABI was found to predict poor MBG. Conclusion Coronary artery disease (CAD) is well linked to PAD. MBG can be used to assess coronary MVO after primary PCI. Poor MBG is associated with low ABI. This could establish a relationship between PAD and coronary MVO after primary PCI.
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Affiliation(s)
- Ahmed Abdel-Galeel
- Cardiovascular Medicine Department, Assiut University Heart Hospital, Assiut University, Assiut, Egypt
| | | | - Hosam Hasan-Ali
- Cardiovascular Medicine Department, Assiut University Heart Hospital, Assiut University, Assiut, Egypt
| | - Ahmed Ibrahim
- Community Medicine Department, Assiut University, Assiut, Egypt
| | - Ayman Ibrahim
- Cardiology Department, Aswan University, Aswan, Egypt
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30
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Ezeofor V‘S, Bray N, Bryning L, Hashmi F, Hoel H, Parker D, Edwards RT. Economic model to examine the cost-effectiveness of FlowOx home therapy compared to standard care in patients with peripheral artery disease. PLoS One 2021; 16:e0244851. [PMID: 33444396 PMCID: PMC7808667 DOI: 10.1371/journal.pone.0244851] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 12/17/2020] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Critical limb ischaemia is a severe stage of lower limb peripheral artery disease which can lead to tissue loss, gangrene, amputation and death. FlowOx™ therapy is a novel negative-pressure chamber system intended for home use to increase blood flow, reduce pain and improve wound healing for patients with peripheral artery disease and critical limb ischaemia. METHODS A Markov model was constructed to assess the relative cost-effectiveness of FlowOx™ therapy compared to standard care in lower limb peripheral artery disease patients with intermittent claudication or critical limb ischaemia. The model used data from two European trials of FlowOx™ therapy and published evidence on disease progression. From an NHS analysis perspective, various FlowOx™ therapy scenarios were modelled by adjusting the dose of FlowOx™ therapy and the amount of other care received alongside FlowOx™ therapy, in comparison to standard care. RESULTS In the base case analysis, consisting of FlowOx™ therapy plus nominal care, the cost estimates were £12,704 for a single dose of FlowOx™ therapy per annum as compared with £15,523 for standard care. FlowOx™ therapy patients gained 0.27 additional quality adjusted life years compared to standard care patients. This equated to a dominant incremental cost-effectiveness ratio per QALY gained. At the NICE threshold WTP of £20,000 and £30,000 per QALY gained, FlowOx™ therapy in addition to standard care had a 0.80 and 1.00 probability of being cost-effectiveness respectively. CONCLUSIONS FlowOx™ therapy delivered as a single annual dose may be a cost-effective treatment for peripheral artery disease. FlowOx™ therapy improved health outcomes and reduced treatment costs in this modelled cohort. The effectiveness and cost-effectiveness of FlowOx™ therapy is susceptible to disease severity, adherence, dose and treatment cost. Research assessing the impact of FlowOx™ therapy on NHS resource use is needed in order to provide a definitive economic evaluation.
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Affiliation(s)
- Victory ‘Segun Ezeofor
- Centre for Health Economics and Medicines Evaluation, Bangor University, Bangor, Gwynedd, Wales, United Kingdom
- * E-mail:
| | - Nathan Bray
- Centre for Health Economics and Medicines Evaluation, Bangor University, Bangor, Gwynedd, Wales, United Kingdom
| | - Lucy Bryning
- Centre for Health Economics and Medicines Evaluation, Bangor University, Bangor, Gwynedd, Wales, United Kingdom
| | - Farina Hashmi
- School of Health and Society, University of Salford, Manchester, United Kingdom
| | - Henrik Hoel
- Otivio AS, Oslo, Norway
- Department of Vascular Surgery, Oslo University Hospital, Oslo, Norway
| | - Daniel Parker
- School of Health and Society, University of Salford, Manchester, United Kingdom
| | - Rhiannon Tudor Edwards
- Centre for Health Economics and Medicines Evaluation, Bangor University, Bangor, Gwynedd, Wales, United Kingdom
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31
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Boylan L, Nesbitt C, Wilson L, Allen J, Sims A, Guri I, Mawson P, Oates C, Stansby G, Investigators OBOTN. Reliability of the Edinburgh Claudication Questionnaire for Identifying Symptomatic PAD in General Practice. Angiology 2021; 72:474-479. [PMID: 33401955 DOI: 10.1177/0003319720984882] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The Edinburgh Claudication Questionnaire (ECQ) was developed to help identify peripheral arterial disease (PAD) in the general population but has not been validated against diagnostic arterial imaging methods such as Duplex Vascular Ultrasound Scanning (DUS). In the present study, we assessed the accuracy of the ECQ for diagnosis using DUS. As part of a National Institute of Health Research funded project looking at novel diagnostic methods, 250 patients were studied from 15 general practices across North East England from May 2015 and November 2016. Practices identified those with a PAD diagnosis from their registers as well as age- and sex-matched controls. All the ECQs were recorded by a vascular specialist nurse. Duplex vascular ultrasound scanning was used as a reference standard for the diagnosis of occlusive PAD. The ECQ had a sensitivity of 52.5% (95% CI: 42.3%-62.5%), specificity of 87.1% (95% CI: 80.6%-92.0%), positive likelihood ratio of 4.06 (95% CI: 2.57-6.42), and negative likelihood ratio of 0.55 (95% CI: 0.44-0.68) compared with reference standard DUS. The ECQ has relatively poor overall diagnostic test accuracy in isolation. It may be helpful in ruling out PAD or as a supplementary test to improve diagnosis of symptomatic disease in General Practice.
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Affiliation(s)
- Luke Boylan
- Northern Vascular Centre, Freeman Hospital, 5983The Newcastle upon Tyne NHS Hospitals Foundation Trust, Newcastle upon Tyne, United Kingdom.,12186Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Craig Nesbitt
- 12186Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Lesley Wilson
- Northern Vascular Centre, Freeman Hospital, 5983The Newcastle upon Tyne NHS Hospitals Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - John Allen
- 12186Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom.,Northern Medical Physics and Clinical Engineering, Freeman Hospital, 5983The Newcastle upon Tyne NHS Hospitals Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Andrew Sims
- 12186Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom.,Northern Medical Physics and Clinical Engineering, Freeman Hospital, 5983The Newcastle upon Tyne NHS Hospitals Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Ina Guri
- 12186Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom.,Northern Medical Physics and Clinical Engineering, Freeman Hospital, 5983The Newcastle upon Tyne NHS Hospitals Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Philip Mawson
- Newcastle Joint Research Office, Gosforth, Newcastle upon Tyne, United Kingdom
| | - Crispian Oates
- Northern Medical Physics and Clinical Engineering, Freeman Hospital, 5983The Newcastle upon Tyne NHS Hospitals Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Gerard Stansby
- Northern Vascular Centre, Freeman Hospital, 5983The Newcastle upon Tyne NHS Hospitals Foundation Trust, Newcastle upon Tyne, United Kingdom.,12186Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
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32
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Kalantzi K, Tentolouris N, Melidonis AJ, Papadaki S, Peroulis M, Amantos KA, Andreopoulos G, Bellos GI, Boutel D, Bristianou M, Chrisis D, Dimitsikoglou NA, Doupis J, Georgopoulou C, Gkintikas SA, Iraklianou S, Kanellas Κ, Kotsa K, Koufakis T, Kouroglou M, Koutsovasilis AG, Lanaras L, Liouri E, Lixouriotis C, Lykoudi A, Mandalaki E, Papageorgiou E, Papanas N, Rigas S, Stamatelatou MI, Triantafyllidis I, Trikkalinou A, Tsouka AN, Zacharopoulou O, Zoupas C, Tsolakis I, Tselepis AD. Efficacy and Safety of Adjunctive Cilostazol to Clopidogrel-Treated Diabetic Patients With Symptomatic Lower Extremity Artery Disease in the Prevention of Ischemic Vascular Events. J Am Heart Assoc 2020; 10:e018184. [PMID: 33327737 PMCID: PMC7955466 DOI: 10.1161/jaha.120.018184] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Background Type 2 diabetes mellitus is a risk factor for lower extremity arterial disease. Cilostazol expresses antiplatelet, anti‐inflammatory, and vasodilator actions and improves the claudication intermittent symptoms. We investigated the efficacy and safety of adjunctive cilostazol to clopidogrel‐treated patients with type 2 diabetes mellitus exhibiting symptomatic lower extremity arterial disease, in the prevention of ischemic vascular events and improvement of the claudication intermittent symptoms. Methods and Results In a prospective 2‐arm, multicenter, open‐label, phase 4 trial, patients with type 2 diabetes mellitus with intermittent claudication receiving clopidogrel (75 mg/d) for at least 6 months, were randomly assigned in a 1:1 ratio, either to continue to clopidogrel monotherapy, without receiving placebo cilostazol (391 patients), or to additionally receive cilostazol, 100 mg twice/day (403 patients). The median duration of follow‐up was 27 months. The primary efficacy end point, the composite of acute ischemic stroke/transient ischemic attack, acute myocardial infarction, and death from vascular causes, was significantly reduced in patients receiving adjunctive cilostazol compared with the clopidogrel monotherapy group (sex‐adjusted hazard ratio [HR], 0.468; 95% CI, 0.252–0.870; P=0.016). Adjunctive cilostazol also significantly reduced the stroke/transient ischemic attack events (sex‐adjusted HR, 0.38; 95% CI, 0.15–0.98; P=0.046) and improved the ankle‐brachial index and pain‐free walking distance values (P=0.001 for both comparisons). No significant difference in the bleeding events, as defined by Bleeding Academic Research Consortium criteria, was found between the 2 groups (sex‐adjusted HR, 1.080; 95% CI, 0.579–2.015; P=0.809). Conclusions Adjunctive cilostazol to clopidogrel‐treated patients with type 2 diabetes mellitus with symptomatic lower extremity arterial disease may lower the risk of ischemic events and improve intermittent claudication symptoms, without increasing the bleeding risk, compared with clopidogrel monotherapy. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT02983214.
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Affiliation(s)
- Kallirroi Kalantzi
- Atherothrombosis Research Center Laboratory of Biochemistry Department of Chemistry University of Ioannina Greece
| | - Nikolaos Tentolouris
- 1st Department of Propaedeutic Internal Medicine Medical School National and Kapodistrian University of Athens Greece
| | | | - Styliani Papadaki
- Atherothrombosis Research Center Laboratory of Biochemistry Department of Chemistry University of Ioannina Greece
| | - Michail Peroulis
- Atherothrombosis Research Center Laboratory of Biochemistry Department of Chemistry University of Ioannina Greece
| | | | | | | | | | | | - Dimitrios Chrisis
- 3rd Internal Medicine Department and Diabetes Center General Hospital of Nikaia Athens Greece
| | - Nikolaos A Dimitsikoglou
- Atherothrombosis Research Center Laboratory of Biochemistry Department of Chemistry University of Ioannina Greece
| | - John Doupis
- Atherothrombosis Research Center Laboratory of Biochemistry Department of Chemistry University of Ioannina Greece
| | | | - Stergios A Gkintikas
- Division of Endocrinology and Metabolism and Diabetes Center First Department of Internal Medicine Medical School Aristotle University of ThessalonikiAHEPA University Hospital Thessaloniki Greece
| | - Styliani Iraklianou
- 3rd Department of Internal Medicine Center General Hospital "Tzaneio," Piraeus Greece
| | - Κonstantinos Kanellas
- 3rd Department of Internal Medicine Center General Hospital "Tzaneio," Piraeus Greece
| | - Kalliopi Kotsa
- Division of Endocrinology and Metabolism and Diabetes Center First Department of Internal Medicine Medical School Aristotle University of ThessalonikiAHEPA University Hospital Thessaloniki Greece
| | - Theocharis Koufakis
- Division of Endocrinology and Metabolism and Diabetes Center First Department of Internal Medicine Medical School Aristotle University of ThessalonikiAHEPA University Hospital Thessaloniki Greece
| | | | | | - Leonidas Lanaras
- Department of Internal Medicine General Hospital of Lamia Greece
| | - Eirini Liouri
- 3rd Internal Medicine Department and Diabetes Center General Hospital of Nikaia Athens Greece
| | | | - Akrivi Lykoudi
- 3rd Internal Medicine Department and Diabetes Center General Hospital of Nikaia Athens Greece
| | - Efthymia Mandalaki
- Atherothrombosis Research Center Laboratory of Biochemistry Department of Chemistry University of Ioannina Greece
| | - Evanthia Papageorgiou
- 3rd Internal Medicine Department and Diabetes Center General Hospital of Nikaia Athens Greece
| | - Nikolaos Papanas
- Second Department of Internal Medicine Democritus University of Thrace Alexandroupolis Greece
| | - Spyridon Rigas
- 3rd Internal Medicine Department and Diabetes Center General Hospital of Nikaia Athens Greece
| | | | - Ioannis Triantafyllidis
- Atherothrombosis Research Center Laboratory of Biochemistry Department of Chemistry University of Ioannina Greece
| | | | - Aikaterini N Tsouka
- Atherothrombosis Research Center Laboratory of Biochemistry Department of Chemistry University of Ioannina Greece
| | | | | | | | - Alexandros D Tselepis
- Atherothrombosis Research Center Laboratory of Biochemistry Department of Chemistry University of Ioannina Greece
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Comparison of Color Doppler Ultrasound and Ankle-Brachial Pressure Index Measurement in Peripheral Vascular Diseases. Indian J Surg 2020. [DOI: 10.1007/s12262-020-02651-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Fang WC, Chou KM, Sun CY, Lee CC, Wu IW, Chen YC, Pan HC. Thermal Perception Abnormalities Can Predict Diabetic Kidney Disease in Type 2 Diabetes Mellitus Patients. Kidney Blood Press Res 2020; 45:926-938. [PMID: 33053551 DOI: 10.1159/000510479] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 07/26/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Previous studies have illustrated clinical associations between diabetic peripheral neuropathy (DPN) and diabetic kidney disease (DKD). Quantitative sensory testing (QST) can accurately detect thermal perception abnormalities and aid in the early diagnosis of asymptomatic small-fiber DPN in patients with type 2 diabetes. The aim of this study was to determine the predictive value of thermal perception abnormalities by QST to detect DKD. METHODS We prospectively enrolled 432 patients with type 2 diabetes (50.2% male, mean age 57.2 years, and average duration of diabetes 9.9 years) at our hospital between 2016 and 2017. Demographic and clinical data of the patients were recorded and analyzed. Diagnosis and staging of DKD were determined by urinary albumin excretion rate and estimated glomerular filtration rate. The presence of thermal perception abnormalities was determined by QST. Multiple logistic regression and receiver operating characteristic (ROC) analyses were performed to investigate the relationships between thermal perception abnormalities and DKD in these patients. RESULTS In multiple regression analysis, abnormal cold perception in the lower limbs was associated with an increased risk of advanced DKD. Area under the ROC curve analysis revealed that four-limb cold perception abnormalities had the best discriminatory power (0.741 ± 0.053) to predict advanced DKD. CONCLUSIONS Our results demonstrate the value of using thermal perception abnormalities to identify patients with type 2 diabetes also at risk of DKD.
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Affiliation(s)
- Wei-Ching Fang
- Department of Family Medicine, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Kuei-Mei Chou
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan.,Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Chiao-Yin Sun
- Chang Gung University College of Medicine, Taoyuan, Taiwan.,Division of Nephrology, Department of Internal Medicine, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Chin-Chan Lee
- Chang Gung University College of Medicine, Taoyuan, Taiwan.,Division of Nephrology, Department of Internal Medicine, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan.,Community Medicine Research Center, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan
| | - I-Wen Wu
- Chang Gung University College of Medicine, Taoyuan, Taiwan.,Division of Nephrology, Department of Internal Medicine, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan.,Community Medicine Research Center, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Yung-Chang Chen
- Chang Gung University College of Medicine, Taoyuan, Taiwan.,Division of Nephrology, Department of Internal Medicine, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan.,Community Medicine Research Center, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Heng-Chih Pan
- Division of Nephrology, Department of Internal Medicine, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan, .,Community Medicine Research Center, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan,
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Saghdaoui LB, Onida S, Davies AH, Wells M. Why nurses in primary care need to be research active: the case of venous leg ulceration. Br J Community Nurs 2020; 25:422-428. [PMID: 32881607 DOI: 10.12968/bjcn.2020.25.9.422] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Venous leg ulceration (VLU) is predominantly managed in primary care by district nurses, however much of the research takes place in secondary care. This study aimed to identify to what extent nurses are involved in publishing VLU research and to ascertain how much VLU research is conducted in primary care. Three searches of literature published between 2015 and 2020 were undertaken, reviewing VLU publications on interventions, quality of life and qualitative research. Some 37% of intervention studies had one or more nurse authors, compared with 65% of quality of life studies and 86% of qualitative research publications. Of papers that providing details of recruitment, 39% of intervention and quality of life studies included primary care as a recruitment setting. Qualitative studies were more likely to recruit from primary as well as secondary care (50%). Nurses are involved in leading VLU research but are more likely to publish quality of life and qualitative research than intervention studies. The majority of nurse authors in this field are based in academic institutions. A minority of studies utilise primary care as a recruitment setting for VLU research. More must be done to enable VLU research in community settings and to promote the involvement of clinical nurses in research.
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Affiliation(s)
- Layla Bolton Saghdaoui
- Clinical Research Nurse and Pre-doctoral Fellow, Imperial College Healthcare NHS Trust and Imperial College London
| | - Sarah Onida
- National Institute for Health Research Clinical Lecturer in Vascular Surgery and Vascular Specialty Registrar, Imperial College Healthcare NHS Trust and Imperial College London
| | - Alun Huw Davies
- Professor of Surgery and Honorary Consultant, Imperial College Healthcare NHS Trust and Imperial College London
| | - Mary Wells
- Professor of Practice in Cancer Nursing and Lead Nurse for Research, Imperial College Healthcare NHS Trust and Imperial College London
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Adeleye OO, Ugwu ET, Gezawa ID, Okpe I, Ezeani I, Enamino M. Predictors of intra-hospital mortality in patients with diabetic foot ulcers in Nigeria: data from the MEDFUN study. BMC Endocr Disord 2020; 20:134. [PMID: 32859203 PMCID: PMC7455894 DOI: 10.1186/s12902-020-00614-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Accepted: 08/24/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Diabetic foot ulcers (DFU) are associated with high morbidity and mortality globally. Mortality in patients hospitalized for DFU in Nigeria is unacceptably high. This study was undertaken to determine factors that predict mortality in patients hospitalized for DFU in Nigeria. METHODS The current study was part of Multi-centre Evaluation of Diabetic Foot Ulcer in Nigeria (MEDFUN), an observational study conducted in six tertiary healthcare institutions across the 6 geopolitical zones of Nigeria. Consecutive type 1 or 2 diabetic patients hospitalized for DFU who consented to participate were recruited and subjected to relevant clinical, biochemical, and radiological assessments and multidisciplinary care until discharge or death. Data for type 1 diabetes mellitus (DM) patients were expunged from current mortality analysis due to their small number. RESULTS Three hundred and twenty-three type 2 DM subjects with mean age and mean duration of DM of 57.2 ± 11.4 years and 8.7 ± 5.8 years respectively participated in this study. The median duration of ulcers was 39 days with a range of 28 to 54 days and the majority (79.9%) presented with advanced ulcers of at least Wagner grade 3. Mortality of 21.4% was recorded in the study, with the highest mortality observed among subjects with Wagner grade 5. Variables significantly associated with mortality with their respective p values were DM duration more than 120 months (p 0.005), ulcer duration > 1 month (p 0.020), ulcer severity of Wagner grade 3 and above (p 0.001), peripheral arterial disease (p 0.005), proteinuria (p < 0.001), positive blood cultures (p < 0.001), low HDL (p < 0.001), shock at presentation (p < 0.001), cardiac failure (p 0.027), and renal impairment (p < 0.001). On Multivariate regression analysis, presence of bacteraemia (OR 5.053; 95% CI 2.572-9.428) and renal impairment (OR 2.838; 95% CI 1.349-5.971) were significantly predictive of mortality independent of other variables. CONCLUSIONS This study showed high intra-hospital mortality among patients with DFU, with the majority of deaths occurring among those with advanced ulcers, bacteraemia, cardiac failure, and renal impairment. Prompt attention to these factors might help improve survival from DFU in Nigeria.
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Affiliation(s)
| | - Ejiofor T. Ugwu
- Department of Medicine, Enugu State University of Science and Technology Enugu, Enugu, Nigeria
| | | | - Innocent Okpe
- Department of Medicine, Ahmadu Bello University Zaria, Zaria, Nigeria
| | - Ignatius Ezeani
- Department of Medicine, Federal Medical Center Umuahia, Umuahia, Abia Nigeria
| | - Marcelina Enamino
- Department of Medicine, Federal Medical Center Keffi, Keffi, Nasarawa Nigeria
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Farahati S, Hosseini SRA, Moazzami M, Daloee MH, Daloee SH. The Impact of High-Intensity Interval Training Versus Moderate-Intensity Continuous Training on Carotid Intima-Media Thickness and Ankle-Brachial Index in Middle-Aged Women. Int J Prev Med 2020; 11:62. [PMID: 32577192 PMCID: PMC7297415 DOI: 10.4103/ijpvm.ijpvm_524_18] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Accepted: 03/14/2019] [Indexed: 11/09/2022] Open
Abstract
Objective: Obesity has been linked to cardiovascular risk factors characterized by endothelial dysfunction and arterial wall thickening. Regular exercise training is recognized as a powerful tool to improve endothelial function and cardiovascular risk profile, but it is unknown which of high-intensity interval training or moderate-intensity continuous training is the best exercise. Materials and Methods: A total of 33 inactive and overweight women aged 40–50 years old and body mass index >27 kg/m2 were randomized to high-intensity interval training, moderate-intensity continuous training, or control. The exercise intervention consisted of 12 weeks of training and three supervised sessions per week. The moderate-intensity group was trained continuously for 47 min at 60–70% of maximal heart rate. High-intensity interval training consisted of four interval bouts of 4 min at 85%–95% of maximal heart rate with 3 min breaks at 50%–60% of maximal heart rate between the intervals. For all analyses, statistical significance was assigned at P < 0.05. Results: According to our findings, while carotid intima-media thickness decreased in both training groups, this reduction was not statistically significant. In the high-intensity training group, the right ankle-brachial index increased significantly (P = 0.007). Conclusion: Twelve weeks of exercise training, especially in high-intensity interval training, have led to improving lipid profiles and endothelial function, it can be said that regular and prolonged exercise can probably be a preventive factor in cardiovascular disease in overweight women.
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Affiliation(s)
- Samaneh Farahati
- Department of Sports Physiology, Faculty of Sport Sciences, Ferdowsi University of Mashhad, Mashhad, Iran
| | | | - Mahtab Moazzami
- Department of Sports Physiology, Faculty of Sport Sciences, Ferdowsi University of Mashhad, Mashhad, Iran
| | - Mahdi Hasanzadeh Daloee
- Department of Cardiology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
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Saku K, Tahara N, Takaseya T, Otsuka H, Takagi K, Shojima T, Shintani Y, Zaima Y, Kikusaki S, Fukuda T, Oryoji A, Nishino Y, Matsui T, Kakuma T, Akiba J, Fukumoto Y, Yamagishi SI, Tanaka H. Pathological Role of Receptor for Advanced Glycation End Products in Calcified Aortic Valve Stenosis. J Am Heart Assoc 2020; 9:e015261. [PMID: 32552251 PMCID: PMC7670521 DOI: 10.1161/jaha.119.015261] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Background Aortic stenosis (AS) is highly prevalent in patients with atherosclerotic cardiovascular disease. Advanced glycation end products (AGEs) and the receptor for AGEs (RAGE) play a pivotal role for vascular calcification in atherosclerosis. We hypothesize that the AGEs-RAGE axis could also be involved in the pathophysiological mechanism of calcified AS. Methods and Results A total of 54 patients with calcified AS who underwent aortic valve replacement were prospectively enrolled from 2014 to 2016 (mean age 75.3±7.7 years). Aortic valve specimens were obtained from 47 patients and 16 deceased control subjects without aortic valve disease (mean age 63.2±14.5 years). The valvular expression of RAGE was evaluated by immunohistochemistry. Serum levels of AGEs and soluble RAGE were measured in 50 patients with calcified AS and 70 age-matched and sex-matched control subjects without heart disease. The valvular RAGE expression in patients with calcified AS was higher than controls (P=0.004) and was significantly associated with a decreased ankle-brachial pressure index (P=0.007) and an increased intima-media thickness (P=0.026). RAGE and α-smooth muscle actin were coexpressed and were partially costained with osteocalcin and alkaline phosphatase. The serum levels of AGEs and soluble RAGE were significantly higher in the patients with calcified AS than in the controls (P=0.013 and P<0.001, respectively). Soluble RAGE (inversely) and use of aspirin were independently correlated with changes in left ventricular systolic function after aortic valve replacement (P=0.012 and P=0.002, respectively). Conclusions Our present study suggests that RAGE may play a role in the pathogenesis of calcified AS, which is a prognostic marker in patients with AS after aortic valve replacement.
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Affiliation(s)
- Kosuke Saku
- Department of Surgery Kurume University School of Medicine Kurume Japan
| | - Nobuhiro Tahara
- Division of Cardiovascular Medicine Department of Medicine Kurume University School of Medicine Kurume Japan
| | - Tohru Takaseya
- Department of Surgery Kurume University School of Medicine Kurume Japan
| | - Hiroyuki Otsuka
- Department of Surgery Kurume University School of Medicine Kurume Japan
| | - Kazuyoshi Takagi
- Department of Surgery Kurume University School of Medicine Kurume Japan
| | - Takahiro Shojima
- Department of Surgery Kurume University School of Medicine Kurume Japan
| | - Yusuke Shintani
- Department of Surgery Kurume University School of Medicine Kurume Japan
| | - Yasuyuki Zaima
- Department of Surgery Kurume University School of Medicine Kurume Japan
| | - Satoshi Kikusaki
- Department of Surgery Kurume University School of Medicine Kurume Japan
| | - Tomofumi Fukuda
- Department of Surgery Kurume University School of Medicine Kurume Japan
| | - Atsunobu Oryoji
- Department of Surgery Kurume University School of Medicine Kurume Japan
| | - Yuri Nishino
- Department of Pathophysiology and Therapeutics of Diabetic Vascular Complications Kurume University School of Medicine Kurume Japan
| | - Takanori Matsui
- Department of Pathophysiology and Therapeutics of Diabetic Vascular Complications Kurume University School of Medicine Kurume Japan
| | | | - Jun Akiba
- Department of Diagnostic Pathology Kurume University Hospital Kurume Japan
| | - Yoshihiro Fukumoto
- Division of Cardiovascular Medicine Department of Medicine Kurume University School of Medicine Kurume Japan
| | - Sho-Ichi Yamagishi
- Division of Diabetes, Metabolism, and Endocrinology Department of Medicine Showa University School of Medicine Tokyo Japan
| | - Hiroyuki Tanaka
- Department of Surgery Kurume University School of Medicine Kurume Japan
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Emerging technologies for the prevention and management of diabetic foot ulcers. J Tissue Viability 2020; 29:61-68. [DOI: 10.1016/j.jtv.2020.03.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 12/27/2019] [Accepted: 03/14/2020] [Indexed: 12/14/2022]
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Chandran J, Wadhwa N, Madhu SV, Kumar R, Sharma S. Monocyte CD36 expression associates with atherosclerotic burden in diabetes mellitus. Diabetes Res Clin Pract 2020; 163:108156. [PMID: 32333967 DOI: 10.1016/j.diabres.2020.108156] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 03/31/2020] [Accepted: 04/14/2020] [Indexed: 11/21/2022]
Abstract
BACKGROUND By virtue of its role in oxidized low-density lipoprotein uptake and foam cell transformation, monocyte CD36 (mCD36) is a potential non-invasive tool to detect atherosclerosis (ATH) in patients of type 2 diabetes mellitus (DM). METHODS Flowcytometric expression of mCD36 was evaluated with reference to ankle brachial index (ABI) in 70 patients of type 2 DM [40 with and 30 without coronary artery disease (CAD) respectively] and 30 age and gender matched normoglycemic controls (NGCs). RESULTS DM patients had significantly higher mCD36 indices than NGCs (p < 0.001). The mCD36 expression was significantly higher in DM persons with CAD and those with poor glycemia control (glycosylated haemoglobin, HbA1c ≥ 7%) than their respective counterparts (p < 0.001 for both). Thirty subjects had compromised ABI (≤0.9); all were DM persons with CAD. ABI compromised subjects had consistently higher mCD36 indices than all other sub-groups (p < 0.001 for all comparisons). Notably, within the ABI-uncompromised group, mCD36 indices differed significantly and showed progressive increase from NGCs to diabetics without and with CAD respectively. CONCLUSIONS mCD36 plays an important role in atherogenesis. With reference to ABI, mCD36 performed robustly as a marker of ATH. Furthermore, it could stratify subjects within the 'ABI-uncompromised group' commensurate with their conventional clinico-pathological ATH risk predisposition.
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Affiliation(s)
- Jayanthi Chandran
- Department of Pathology, University College of Medical Sciences & Guru Teg Bahadur Hospital, University of Delhi, Delhi 110095, India; Department of Pathology, Sri Manakula Vinayagar Medical College and Hospital, Puducherry, India(1)
| | - Neelam Wadhwa
- Department of Pathology, University College of Medical Sciences & Guru Teg Bahadur Hospital, University of Delhi, Delhi 110095, India.
| | - S V Madhu
- Department of Endocrinology, University College of Medical Sciences & Guru Teg Bahadur Hospital, University of Delhi, Delhi 110095, India
| | - Rajive Kumar
- Department of Laboratory Oncology, Institute of Rotary Cancer Hospital, All India Institute of Medical Sciences, Delhi 110029, India; Department of Pathology, Mahavir Cancer Institute and Research Centre, Patna 801505, India(1)
| | - Satendra Sharma
- Department of Pathology, University College of Medical Sciences & Guru Teg Bahadur Hospital, University of Delhi, Delhi 110095, India
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Liu L, Sun H, Nie F, Hu X. Prognostic Value of Abnormal Ankle–Brachial Index in Patients With Coronary Artery Disease: A Meta-Analysis. Angiology 2020; 71:491-497. [PMID: 32166959 DOI: 10.1177/0003319720911582] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The prognostic value of the ankle–brachial index (ABI) in patients with coronary artery disease (CAD) remains undefined. This meta-analysis sought to investigate the association of abnormal ABI and adverse outcomes in patients with CAD. PubMed, Embase, China National Knowledge Infrastructure, VIP, and Wanfang databases were comprehensively searched for studies published from inception to September 10, 2019. All observational studies investigating the association of abnormal baseline ABI and risk of major adverse cardiovascular events (MACE) or all-cause mortality were selected. Normal ABI is usually defined as between 0.9 and 1.4. The prognostic values were summarized by pooling risk ratio (RR) with 95% confidence intervals (CIs) for abnormal versus normal ABI category. Nine (9384 patients with CAD) studies were included. Abnormal ABI was independently associated with MACE (RR: 2.46; 95% CI: 2.02-2.99) and all-cause mortality (RR: 1.74; 95% CI: 1.32-2.30). Subgroup analysis showed that the pooled RR for MACE was 2.34 (95% CI: 1.73-3.16) for an abnormal low ABI. Abnormal ABI predicts MACE and all-cause mortality in patients with CAD, even after adjusting conventional confounding factors. However, the prognostic value of abnormal ABI is mainly dominated by a low ABI rather than a high ABI.
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Affiliation(s)
- Longguang Liu
- Department of Vascular and Thyroid Surgery, The First Affiliated Hospital, China Medical University, Shenyang, China
| | - Hongxiao Sun
- Department of Vascular and Thyroid Surgery, The First Affiliated Hospital, China Medical University, Shenyang, China
| | - Fengze Nie
- Department of Vascular and Thyroid Surgery, The First Affiliated Hospital, China Medical University, Shenyang, China
| | - Xinhua Hu
- Department of Vascular and Thyroid Surgery, The First Affiliated Hospital, China Medical University, Shenyang, China
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Abstract
Peripheral artery disease of the lower limbs is a chronically progressive disorder characterised by the presence of occlusive lesions in the medium and large arteries that result in symptoms secondary to insufficient blood flow to the lower extremities. It is both a manifestation of systemic atherosclerosis and a marker of increased cardiovascular morbidity and mortality. Because of its highly heterogenous clinical picture, a detailed history and physical assessment, a high degree of suspicion for peripheral artery disease and the use of the ankle-brachial pressure index is essential to identify patients with peripheral artery disease. This will allow early administration of basic pharmacotherapy and lifestyle changes to reduce cardiovascular events, minimise claudication symptoms and enable optimal revascularisation to prevent loss of limb function.
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Affiliation(s)
- Keith A Chan
- Section of Adult Cardiology, Chong Hua Heart Institute, Cebu City, Philippines
| | - Alex Junia
- Section of Adult Cardiology, Chong Hua Heart Institute, Cebu City, Philippines
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AbuRahma AF, Adams E, AbuRahma J, Mata LA, Dean LS, Caron C, Sloan J. Critical analysis and limitations of resting ankle-brachial index in the diagnosis of symptomatic peripheral arterial disease patients and the role of diabetes mellitus and chronic kidney disease. J Vasc Surg 2020; 71:937-945. [PMID: 31471230 PMCID: PMC7203622 DOI: 10.1016/j.jvs.2019.05.050] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Accepted: 05/15/2019] [Indexed: 11/20/2022]
Abstract
BACKGROUND The ankle-brachial index (ABI) may underestimate the severity of peripheral arterial disease (PAD) in patients with noncompressible vessels. This study analyzed limitations of the ABI and toe-brachial index (TBI), if done alone, in patients with symptomatic PAD, diagnosed by duplex ultrasound (DUS) examination, particularly in patients with diabetes and chronic kidney disease (CKD). METHODS This is a retrospective review of prospectively collected data. All patients underwent resting ABIs, TBI, and/or DUS. An ABIs of 0.90 or less in either leg was considered abnormal, and the term inconclusive ABIs (noncompressibility) was used if the ABI was 1.3 or greater. The sensitivity, specificity, positive predictive value, negative predictive value, and overall accuracy (OA) of ABIs in detecting 50% or greater stenosis of any arterial segment based on DUS were determined. A TBI of less than 0.7 was considered abnormal. RESULTS We included 2226 ABIs and 1383 DUS examinations: 46% of patients had diabetes, 16% had CKD, and 39% had coronary artery disease. Fifty-three percent of the ABIs were normal, 34% were abnormal, and 13% were inconclusive. For patients with limb-threatening ischemia, 40% had normal ABIs, 40% abnormal ABIs, and 20% were inconclusive. The sensitivity and OA for ABIs in detecting 50% or greater stenosis in the whole series were 57% (95% confidence interval [CI], 53.7-61.2) and 74% (95% CI, 71.9-76.6); for diabetics 51% (95% CI, 46.1-56.3) and 66% (95% CI, 62.3-69.8); nondiabetics 66% (95% CI, 59.9-70.9) and 81% (95% CI, 78.2-83.9). For patients with CKD, the sensitivity and OA for ABIs in detecting 50% or greater stenosis was 43% (95% CI, 34.3-52.7) and 67% (95% CI, 60.2-73.0) versus patients with no CKD 60% (95% CI, 56.3-64.6) and 76% (95% CI, 73.1-78.1). If patients with inconclusive ABIs were excluded, these values were 69% (95% CI, 65.2-72.9) and 80% (95% CI, 77.2-81.9) in the whole series; 67% (95% CI, 61.6-72.7) and 75% (95% CI, 70.5-78.4) for diabetics; and 63% (95% CI, 51.3-73.0) and 78% (95% CI, 70.6-83.9) for patients with CKD. Thirty-three percent of TBIs were normal and 67% were abnormal. The sensitivity and OA for abnormal TBI in detecting 50% or greater stenosis were 85% (95% CI, 78.9-90.0) and 75% (95% CI, 70.1-80.2) in the whole series; 84% (95% CI, 76.0-90.3) and 74% (95% CI, 67.1-80.2) for diabetics; and 77% (95% CI, 61.4-88.2) and 72% (95% CI, 59.9-82.3) for patients with CKD. For those with inconclusive ABIs, these values for TBI were 75% and 69%. CONCLUSIONS Of symptomatic patients with PAD with 50% or greater stenosis on DUS examination, 43% had normal/inconclusive resting ABIs (49% in diabetics and 57% in CKD). TBI may help in patients with inconclusive ABIs. These patients should undergo further imaging to determine proper treatment.
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Affiliation(s)
- Ali F AbuRahma
- Department of Surgery, West Virginia University, Charleston, WV.
| | - Elliot Adams
- Department of Surgery, West Virginia University, Charleston, WV
| | - Joseph AbuRahma
- Department of Anesthesiology, University of Florida College of Medicine, Gainesville, Fla
| | - Luis A Mata
- Department of Surgery, West Virginia University, Charleston, WV
| | - L Scott Dean
- CAMC Health Education and Research Institute, Charleston, WV
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Bartella AK, Luderich C, Kamal M, Braunschweig T, Steegmann J, Modabber A, Kloss-Brandstätter A, Hölzle F, Lethaus B. Ankle Brachial Index Predicts for Difficulties in Performing Microvascular Anastomosis. J Oral Maxillofac Surg 2020; 78:1020-1026. [PMID: 32087118 DOI: 10.1016/j.joms.2020.01.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 01/17/2020] [Accepted: 01/17/2020] [Indexed: 10/25/2022]
Abstract
PURPOSE In reconstructive microsurgery, severe arteriosclerosis is a known predictor for free flap failure because of problems with the vascular anastomosis. We investigated whether the ankle brachial index (ABI) could be a suitable preoperative measurement for the prediction of compromise regarding vascular anastomosis in patients undergoing microsurgical reconstruction. MATERIAL AND METHODS We conducted a prospective cohort study of patients who had undergone reconstructive microvascular surgery in a tertiary care center from 2015 to 2017. The ABI was preoperatively assessed by dividing the systolic blood pressure measured at the ankle by the brachial systolic blood pressure. Results from 0.9 to 1.3 are within the physiologic range. Values less than 0.9 indicate moderate to severe arteriosclerosis, and those greater than 1.3 indicate the major form of arteriosclerosis with complete calcification of the tunica media. The ABI value correlated with the ease of the anastomosis (rated from 1 [very straightforward] through 5 [very difficult]), gross examination findings (intraluminal plaque [yes vs no]), and the necessity of plaque removal before anastomosis (yes vs no). In addition, cross-sectional specimens were obtained from the arteries and veins of the donor and recipient sites intraoperatively. The specimens were rated histologically for the arteries and veins using an ordinal scale. Histologic evaluation was performed to confirm and objectify the results from the ABI. Statistical analysis was performed using SPSS software, version 24.0 (IBM Corp, Armonk, NY) and t tests, analysis of variance, and χ2 tests. RESULTS The sample included 41 patients with a mean age of 56.7 years; 59% were men. The mean ABI was 1.06. The mean ease of anastomosis was 1.8. The mean ABI was associated with the ease of anastomosis. A pathologic ABI was significantly related to problems with the arterial anastomosis (P = .004) and increased arteriosclerosis in the arteries from the donor (P = .047) and recipient (P = .036) sites. CONCLUSIONS A pathologic ABI was associated with increased difficulty with the microvascular anastomosis.
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Affiliation(s)
- Alexander K Bartella
- Resident, Department of Maxillofacial Surgery, RWTH Aachen University, Aachen, Germany; and Resident, Department of Maxillofacial Surgery, Leipzig University, Leipzig, Germany.
| | - Carolin Luderich
- Resident, Department of Maxillofacial Surgery, RWTH Aachen University, Aachen, Germany
| | - Mohammad Kamal
- Assistant Professor, Department of Surgical Sciences, Faculty of Dentistry, Kuwait University, Safat, Kuwait
| | - Till Braunschweig
- Consultant, Department of Pathology, RWTH Aachen University, Aachen, Germany
| | - Julius Steegmann
- Resident, Department of Maxillofacial Surgery, RWTH Aachen University, Aachen, Germany
| | - Ali Modabber
- Consultant, Department of Maxillofacial Surgery, RWTH Aachen University, Aachen, Germany
| | - Anita Kloss-Brandstätter
- Assistant Professor, Department of Engineering & IT, Carinthia University of Applied Sciences, Villach, Austria
| | - Frank Hölzle
- Head, Department of Maxillofacial Surgery, RWTH Aachen University, Aachen, Germany
| | - Bernd Lethaus
- Head, Department of Maxillofacial Surgery, Leipzig University, Leipzig, Germany
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Gavrilova NE, Zhatkina MV, Metelskaya VA, Rudenko BA, Drapkina OM. Assessment methods and possibilities of instrumental diagnosis of subclinical atherosclerosis of coronary arteries. КАРДИОВАСКУЛЯРНАЯ ТЕРАПИЯ И ПРОФИЛАКТИКА 2019. [DOI: 10.15829/1728-8800-2019-6-136-141] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Affiliation(s)
| | - M. V. Zhatkina
- National Medical Research Center for Preventive Medicine
| | | | - B. A. Rudenko
- National Medical Research Center for Preventive Medicine
| | - O. M. Drapkina
- National Medical Research Center for Preventive Medicine
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Yang Y, Liu L, Sun H, Nie F, Hu X. Relation between high Ankle-Brachial Index and cardiovascular outcomes in the general population and cardiovascular disease: a meta-analysis. INT ANGIOL 2019; 39:131-138. [PMID: 31814377 DOI: 10.23736/s0392-9590.19.04276-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Conflicting findings have been reported on the association between high Ankle-Brachial Index (ABI) and cardiovascular outcomes. This meta-analysis aimed to assess the association of abnormally high ABI and cardiovascular outcomes in the general population and suspected or established cardiovascular disease (CVD) patients. EVIDENCE ACQUISITION A comprehensive literature search was conducted in PubMed and Embase databases through November 10th, 2018. All observational studies evaluating the association of high ABI with cardiovascular events including stroke, coronary heart disease (CHD), congestive heart failure, and composite of CVD/all-cause mortality in the general population and suspected or established CVD patients were included. We pooled risk ratios (RR) with 95% confidence intervals (CI) for the abnormally high ABI (> 1.3 or >1.4) versus the reference normal ABI category. EVIDENCE SYNTHESIS We identified 10 cohort studies enrolling 39,421 participants. A random effect model meta-analysis indicated that the pooled RR of composite of CVD/all-cause mortality was 1.07 (95% CI 0.83-1.38) in the general population and 1.26 (95% CI 1.03-1.55) in suspected or established CVD patients. Moreover, participants with abnormally high ABI did not increase the risk of stroke (RR 1.60; 95% CI 0.83-3.06) and CHD (RR 1.40; 95% CI 0.87-2.24) in the general population. CONCLUSIONS Abnormally high ABI appears to be associated with an increased risk of a composite of CVD/all-cause mortality in suspected or established CVD patients but not in the general population. However, additional well-designed studies are required to support the current findings.
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Affiliation(s)
- Yu Yang
- Department of Vascular and Thyroid Surgery, The First Affiliated Hospital, China Medical University, Shenyang, China
| | - Longguang Liu
- Department of Vascular and Thyroid Surgery, The First Affiliated Hospital, China Medical University, Shenyang, China
| | - Hongxiao Sun
- Department of Vascular and Thyroid Surgery, The First Affiliated Hospital, China Medical University, Shenyang, China
| | - Fengze Nie
- Department of Vascular and Thyroid Surgery, The First Affiliated Hospital, China Medical University, Shenyang, China
| | - Xinhua Hu
- Department of Vascular and Thyroid Surgery, The First Affiliated Hospital, China Medical University, Shenyang, China -
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Scott J, Lecouturier J, Rousseau N, Stansby G, Sims A, Wilson L, Allen J. Nurses' and patients' experiences and preferences of the ankle-brachial pressure index and multi-site photoplethysmography for the diagnosis of peripheral arterial disease: A qualitative study. PLoS One 2019; 14:e0224546. [PMID: 31697713 PMCID: PMC6837749 DOI: 10.1371/journal.pone.0224546] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2019] [Accepted: 10/16/2019] [Indexed: 01/15/2023] Open
Abstract
Peripheral arterial disease is a global health problem, affecting around 20% of people aged over 60 years. Whilst ankle-brachial pressure index (ABPI) is regularly used for diagnosis, it has a number of limitations, which have presented a need for alternative methods of diagnosis. Multi-site photoplethysmography (MPPG) is one such method, but evidence of acceptability of both methods is lacking. This study aims to describe and compare preferences and experiences amongst nurses and patients of ABPI and MPPG use in primary care. We used qualitative research methods in the context of a clinical diagnostic study comparing ABPI with MPPG. Use of ABPI and MPPG by 13 nurses were observed with 51 patients across general practice surgeries in North-East England in 2015/16. Follow-up semi-structured interviews were conducted with 12 nurses and 27 patients. Data were thematically analysed. Two major themes were identified: (1) device preferences; (2) test discomfort and anxiety. There was a compelling preference for MPPG due to ease of use, speed of the test, patient comfort, and perceived device accuracy/objectivity. However some patients struggled to identify a preference, describing ambivalence to medical testing. ABPI was deemed uncomfortable and painful, particularly when the blood pressure cuff was inflated at the lower limbs. There was also evidence of anxiety amongst patients when their foot pulses were not identified using ABPI. Whilst ABPI is a non-invasive and routine procedure it was associated with a number of drawbacks in clinical practice. Nurses required considerable dexterity to employ the test, and it resulted in anxiety amongst some patients. Conversely, MPPG was deemed to be easier and quicker to use, and perceived to be less subjective. Should diagnostic accuracy and cost be comparable to ABPI, then the findings of this study suggest MPPG would be preferable to ABPI for patients as well as nurses.
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Affiliation(s)
- Jason Scott
- Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, United Kingdom
- * E-mail: (JS); (NR)
| | - Jan Lecouturier
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Nikki Rousseau
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, United Kingdom
- * E-mail: (JS); (NR)
| | - Gerard Stansby
- Northern Vascular Centre, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
- School of Surgical and Reproductive Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Andrew Sims
- Northern Medical Physics and Clinical Engineering Department, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Lesley Wilson
- Northern Vascular Centre, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - John Allen
- Northern Medical Physics and Clinical Engineering Department, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, United Kingdom
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Subramanian N, Xu J, Sayyed Kassem L, Simonson M, Desai N. Absent or diminished pedal pulses and estimated GFR decline in patients with diabetic kidney disease. Ren Fail 2019; 41:691-697. [PMID: 31352861 PMCID: PMC6711125 DOI: 10.1080/0886022x.2019.1638273] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 05/21/2019] [Accepted: 06/22/2019] [Indexed: 12/19/2022] Open
Abstract
Background: Peripheral artery disease (PAD) is a complication of type 2 diabetes that leads to critical limb ischemia and amputation. We tested whether absent or diminished pedal pulses (ADPPs) predicts subsequent renal functional decline in patients with diabetic chronic kidney disease (CKD). We also examined the association between urinary biomarkers and ADPP as well as worsening CKD. Methods: Using a prospective longitudinal design, we studied 91 patients with type 2 diabetes and estimated glomerular filtration rate (eGFR) from 7 to 146 mL/min/1.73 m2. Baseline pedal pulses were assessed by standardized history and physical examination. The primary endpoint was decline in eGFR >30%. Potential confounders of the relationship between pedal pulses and eGFR were assessed by multivariable logistic regression. Results: Of 91 participants (median age 58 (range 30-83); median eGFR 72.4 ± 33.4 mL/min/1.73 m2), 43% had at least one ADPP. Baseline ADPP associated with increased risk of greater than 30% decline in eGFR (OR= 3.67, p = .004). This association remained significant (OR = 3.09, p = .029) after adjustment for traditional risk factors of renal function decline in diabetic kidney disease (DKD). In addition, urinary endothelin-1 (ET-1) was higher among patients with ADPP (p =.0006) and associated with eGFR decline greater than 30% (adjusted OR = 1.81, p = .035). Conclusions: ADPP is a strong predictor of decline in renal function in type 2 diabetes. Patients with type 2 diabetes and abnormal pedal pulses should be screened for DKD and monitored closely for progression of CKD.
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Affiliation(s)
- Nivetha Subramanian
- Division of Nephrology and Hypertension, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Jennifer Xu
- Division of Nephrology and Hypertension, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Laure Sayyed Kassem
- Division of Endocrinology, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Michael Simonson
- Division of Nephrology and Hypertension, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Niraj Desai
- Division of Nephrology and Hypertension, Case Western Reserve University School of Medicine, Cleveland, OH, USA
- Department of Medicine, University Hospitals Cleveland Medical Center and Louis Stokes VA Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA
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Abstract
Dermatologists encounter patients with a variety of lower extremity ulcers including those related to venous insufficiency and peripheral arterial disease. Vascular studies, including ankle brachial pressure index, toe pressure, toe brachial index, Doppler arterial waveform, Duplex ultrasonography, and angiography, play an essential role in the prevention, diagnosis, and management of vascular diseases. In fact, dermatologists are often the first medical providers to see patients with complex vascular conditions. Knowledge of the appropriate indications, interpretations, limitations, and advantages of the various vascular studies is critical to the successful and swift management of each patient presenting with a lower extremity ulcer. This study reviews the most commonly ordered arterial and venous studies and discusses the appropriate indications and interpretation of these studies.
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Affiliation(s)
- Ali Rajabi-Estarabadi
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Ahmed Kayssi
- Division of Vascular Surgery, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Afsaneh Alavi
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
- Division of Dermatology, Department of Medicine, Women's College Hospital, 76 Grenville Street, 5th Floor, Toronto, ON, M5S 1B2, Canada.
| | - Robert S Kirsner
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
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Kim YJ. Red flag rules for knee and lower leg differential diagnosis. ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:S250. [PMID: 31728374 PMCID: PMC6828998 DOI: 10.21037/atm.2019.07.62] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Accepted: 06/14/2019] [Indexed: 11/06/2022]
Abstract
Physical therapists can be frequently a patient's initial encounter after a lower extremity injury, as access to physical therapy services have become readily available without a physician's referral. In 2017, over 65% of physical therapy providers are treating via direct access in United States that allow unrestricted access. In addition to direct access, in an age when at least one of four Americans have multiple chronic medical conditions, it is vital to be able to perform a comprehensive examination, which includes a thorough patient history, systems review, and objective test and measures. Physical therapists should identify red flag symptoms and signs indicating possible pathological condition(s). Based on the findings, a clinical decision should be made to either treat the patient, refer the patient to an appropriate healthcare practitioner, or initiate both treatment and referral. If serious pathology is suspected, it is most prudent to refer the patient appropriately to a qualified medical practitioner.
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Affiliation(s)
- Young Jae Kim
- Regulatory & Compliance Coordinator, Rubin Institute of Advanced Orthopedics, Sinai Hospital, Baltimore, MD, USA
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